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Establishing Creditable Coverage under Group Health Plans
OMB 1210-0103
OMB.report
DOL/EBSA
OMB 1210-0103
OMB 1210-0103
Latest Forms, Documents, and Supporting Material
Document
Name
HIPAA_1210-0103ss12.doc
Supporting Statement A
Establishing Creditable Coverage under Group Health Plans
All Historical Document Collections
201211-1210-004
Approved without change
Extension without change of a currently approved collection
2012-12-27
200911-1210-003
Approved without change
Extension without change of a currently approved collection
2009-12-01
200609-1210-002
Approved without change
Extension without change of a currently approved collection
2006-10-16
200412-1210-003
Approved without change
No material or nonsubstantive change to a currently approved collection
2004-12-30
200306-1210-007
Approved without change
Extension without change of a currently approved collection
2003-06-27
200003-1210-004
Approved without change
Extension without change of a currently approved collection
2000-03-30
199801-1210-002
Approved without change
Extension without change of a currently approved collection
1998-01-02
199704-1210-004
Approved without change
New collection (Request for a new OMB Control Number)
1997-04-08
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