Information Collection Request

TD 9724 - Summary of Benefits and Coverage Disclosures

ICR 201604-1545-003 · OMB 1545-2229 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Simple fracture.pdf Supplementary Document Uploaded 2016-04-05 Repair queued
SBC Sample Completed 4 4 clean.doc Supplementary Document Uploaded 2016-04-05 Available
SBC Template 4 4 clean.doc Supplementary Document Uploaded 2016-04-05 Repair queued
UG 4-1-16 -12 pm clean.doc Supplementary Document Uploaded 2016-04-05 Available
Yes Answers 4 1 12 pm clean.doc Supplementary Document Uploaded 2016-04-05 Available
No Answers 4 1 12 pm clean.doc Supplementary Document Uploaded 2016-04-05 Available
maternity-narrative.pdf Supplementary Document Uploaded 2016-04-05 Available
Copy of Copy of coverage_examples_calculator 02 07.xlsm Supplementary Document Uploaded 2016-04-05 Repair queued
coverage_examples_calculator instructions FINAL.docx Supplementary Document Uploaded 2016-04-05 Available
Copy of Managing Type 2 Diabetes.xlsx Supplementary Document Uploaded 2016-04-05 Available
Copy of Simple fracture.xlsx Supplementary Document Uploaded 2016-04-05 Available
Copy of Having a baby.xlsx Supplementary Document Uploaded 2016-04-05 Available
SBC Template 4 4 clean.doc Supplementary Document Uploaded 2016-04-05 Available
SBC Response to Comments 4 5 16 clean.docx Supplementary Document Uploaded 2016-04-05 Available
No Answers 4 1 12 pm clean.doc Supplementary Document Uploaded 2016-04-05 Available
Individual Instructions 4 4 clean.docx Supplementary Document Uploaded 2016-04-05 Available
Group Instructions 4 4 clean.docx Supplementary Document Uploaded 2016-04-05 Repair queued
IRS PRA supporting statement4 4 16(nn).doc Supporting Statement A Uploaded 2016-04-05 Available
IC Document Collections
IC IDCollectionTypeStatusForm
199118 TD 9724 - Summary of Benefits and Coverage Disclosures Modified
ICR Details
1545-2229 201604-1545-003
Historical Active 201409-1545-021
TREAS/IRS Ready
TD 9724 - Summary of Benefits and Coverage Disclosures
Revision of a currently approved collection   No
Regular
Approved without change 04/06/2016
Retrieve Notice of Action (NOA) 04/05/2016
  Inventory as of this Action Requested Previously Approved
04/30/2019 36 Months From Approved 01/31/2019
213,624,047,553 0 79,699,998
431,550 0 649,500
1,749,999,652,592 0 5,035,021

This document contains regulations regarding disclosure of the summary of benefits and coverage and the uniform glossary for group health plans and health insurance coverage in the group and individual markets under the Patient Protection and Affordable Care Act. This document implements the disclosure requirements to help plans and individuals better understand their health coverage, as well as other coverage options. The templates and instructions to be used in making these disclosures are being issued in a separate notice.

PL: Pub.L. 111 - 148 2701- 2719A Name of Law: Affordable Care Act
  
None

Not associated with rulemaking

  79 FR 78578 12/31/2014
81 FR 9945 02/26/2016
Yes

1
IC Title Form No. Form Name
TD 9724 - Summary of Benefits and Coverage Disclosures

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 213,624,047,553 79,699,998 0 0 213,544,347,555 0
Annual Time Burden (Hours) 431,550 649,500 0 0 -217,950 0
Annual Cost Burden (Dollars) 1,749,999,652,592 5,035,021 0 0 1,749,994,617,571 0
No
Yes
Cutting Redundancy
The burden estimates were adjusted to account for new estimates provided by DOL for the number of issuers, plans, participants and beneficiaries and the adjustment of labor rates.

No
No
Yes
Yes
Yes
Uncollected
Karen Levin 202 622-6080 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/05/2016