Information Collection Request
Affordable Care Act Internal Claims and Appeals and External Review Procedures for ERISA Plans
ICR 202503-1210-004 · OMB 1210-0144 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Justification for No Material or Nonsubstantive Change to Currently Approved Collection (OMB Control 1210-0144).docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2025-01-17 | Missing upstream |
| 1210-0144 DOL IFR 2 external review SS 3.20.25.docx |
Supporting Statement A | Uploaded 2025-03-20 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 194302 |  Procedures for Federal External Review and Model Notices Relating to Internal Claims and Appeals and External Review under the Patient Protection and Affordable Care Act |
Other-Model | Modified | |
| 193842 | Group Health Plans Internal Claims and Appeals and External Review Processes |
Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOL/EBSA |
| OMB Control No | 1210-0144 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202501-1210-005 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |