Information Collection Request

TD 9724 - Summary of Benefits and Coverage Disclosures

ICR 201810-1545-024 · OMB 1545-2229 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
1545-2229 Justification for Change 2017-03.docx Justification for No Material/Nonsubstantive Change Uploaded 2017-03-22 Available
Simple fracture.pdf Supplementary Document Uploaded 2016-04-05 Available
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 Available
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 Available
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 Available
2019-03-19_SS_1545-2229r.doc Supporting Statement A Uploaded 2019-03-19 Available
IC Document Collections
IC IDCollectionTypeStatusForm
199118 TD 9724 - Summary of Benefits and Coverage Disclosures Modified
ICR Details
1545-2229 201810-1545-024
Historical Active 201703-1545-005
TREAS/IRS
TD 9724 - Summary of Benefits and Coverage Disclosures
Revision of a currently approved collection   No
Regular
Approved without change 08/07/2019
Retrieve Notice of Action (NOA) 04/30/2019
  Inventory as of this Action Requested Previously Approved
08/31/2022 36 Months From Approved 08/31/2019
72,826,994 0 71,252,326
328,265 0 431,553
7,040,366 0 9,273,266

This document contains previously approved 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

  83 FR 62402 12/03/2018
84 FR 16341 04/18/2019
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 72,826,994 71,252,326 0 0 1,574,668 0
Annual Time Burden (Hours) 328,265 431,553 0 0 -103,288 0
Annual Cost Burden (Dollars) 7,040,366 9,273,266 0 0 -2,232,900 0
No
No
Estimates have been adjusted to account for new estimates of the number of issuers, plans, participants and beneficiaries affected by the information collection. Also labor rates have been adjusted.

$0
No
    No
    No
Yes
Yes
Yes
Uncollected
Kevin Knopf 202 317-5500 [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.
04/30/2019