Information Collection Request

National Medical Support Notice - Part A

ICR 202605-0970-009 · OMB 0970-0222 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 1 National Medical Support Notice Part A Form Unchanged Available
Form 1 National Medical Support Notice Part A Form Unchanged Available
Form 1 National Medical Support Notice Part A Form Modified Available
Form 1 National Medical Support Notice Part A Form Modified Available
Form 1 National Medical Support Notice Part A Form Modified Available
Form 1 National Medical Support Notice Part A Form Modified Available
Form 1 National Medical Support Notice Part A Form Modified Available
Form 1 National Medical Support Notice Part A Form Modified Available
Form 1 National Medical Support Notice Part A Form Removed Available
Form 1 National Medical Support Notice Part A Form Removed Available
Form 1 National Medical Support Notice Part A Form Removed Available
Form 1 National Medical Support Notice Part A Form Removed Available
Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix Form Modified Available
Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix Form Modified Available
Form 1 National Medical Support Notice Part A Form Removed Available
Form 1 National Medical Support Notice Part A Form Removed Available
Form 1 National Medical Support Notice Part A Form Removed Available
Form 1 National Medical Support Notice Part A Form Removed Available
NonSub Change Request _NMSN Burden Adjustment ROCIS.docx Justification for No Material/Nonsubstantive Change Uploaded 2026-05-28 Available
NonSub Change Request _NMSN Burden Adjustment ROCIS.docx Justification for No Material/Nonsubstantive Change Uploaded 2026-05-28 Available
NMSN Response to Comments - 30 Day FRN.docx Supplementary Document Uploaded 2025-11-18 Available
NMSN Response to Comments - 30 Day FRN.docx Supplementary Document Uploaded 2025-11-18 Available
2025-08-29 NMSN Part A Supporting Statement FINAL_9.12.25 - burden exp update 2026_clean.docx Supporting Statement A Uploaded 2026-05-28 Available
2025-08-29 NMSN Part A Supporting Statement FINAL_9.12.25 - burden exp update 2026_clean.docx Supporting Statement A Uploaded 2026-05-28 Available
IC Document Collections
IC IDCollectionTypeStatusForm
277536 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - 2026 Forward Form UnchangedNational Medical Support Notice Part A
277536 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - 2026 Forward Form UnchangedNational Medical Support Notice Part A
277536 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - 2026 Forward Instruction Unchanged
277535 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - 2026 Forward Form ModifiedNational Medical Support Notice Part A
277535 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - 2026 Forward Form ModifiedNational Medical Support Notice Part A
277535 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - 2026 Forward Instruction Modified
277534 National Medical Support Notice-Part A (Employer Respondents) - 2026 Forward Form ModifiedNational Medical Support Notice Part A
277534 National Medical Support Notice-Part A (Employer Respondents) - 2026 Forward Form ModifiedNational Medical Support Notice Part A
277534 National Medical Support Notice-Part A (Employer Respondents) - 2026 Forward Instruction Modified
277533 National Medical Support Notice-Part A (State Respondents) - 2026 Forward Form ModifiedNational Medical Support Notice Part A
277533 National Medical Support Notice-Part A (State Respondents) - 2026 Forward Form ModifiedNational Medical Support Notice Part A
277533 National Medical Support Notice-Part A (State Respondents) - 2026 Forward Instruction Modified
264137 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - Implementation Year Form RemovedNational Medical Support Notice Part A
264137 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - Implementation Year Form RemovedNational Medical Support Notice Part A
264137 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - Implementation Year Instruction Removed
264134 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - Implementation Year Form RemovedNational Medical Support Notice Part A
264134 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - Implementation Year Form RemovedNational Medical Support Notice Part A
264134 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - Implementation Year Instruction Removed
255976 State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year Form ModifiedState Medical Support Contacts and Program Requirement Matrix
255976 State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year Form ModifiedState Medical Support Contacts and Program Requirement Matrix
236881 National Medical Support Notice-Part A (Employer Respondents) - Implementation Year Form RemovedNational Medical Support Notice Part A
236881 National Medical Support Notice-Part A (Employer Respondents) - Implementation Year Form RemovedNational Medical Support Notice Part A
236881 National Medical Support Notice-Part A (Employer Respondents) - Implementation Year Instruction Removed
10060 National Medical Support Notice-Part A (State Respondents) - Implementation Year Form RemovedNational Medical Support Notice Part A
10060 National Medical Support Notice-Part A (State Respondents) - Implementation Year Form RemovedNational Medical Support Notice Part A
10060 National Medical Support Notice-Part A (State Respondents) - Implementation Year Instruction Removed
ICR Details
0970-0222 202605-0970-009
Active 202509-0970-004
HHS/ACF OCSE
National Medical Support Notice - Part A
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/04/2026
Retrieve Notice of Action (NOA) 05/29/2026
  Inventory as of this Action Requested Previously Approved
12/31/2028 12/31/2028 12/31/2028
9,512,998 0 19,181,513
1,615,119 0 3,251,272
0 0 0

The Office of Child Support Enforcement (OCSE) developed the National Medical Support Notice (NMSN) - Part A in accordance with the Child Support Performance and Incentives Act of 1998 and the Employee Retirement Income Security Act of 1974. The laws required OCSE to promulgate NMSN regulations, which were issued jointly by the Departments of Health and Human Services and Labor. The information collection activities associated with the NMSN are authorized by (1) 42 U.S.C. § 666, which requires all child support orders to include a provision for medical support, and where appropriate, enforced through the National Medical Support Notice; and (2) 29 U.S.C. § 1169, which provides for medical coverage pursuant to a qualified medical support order. The NMSN Part A is a standard, required form that child support agencies (CSAs) use to ensure employers enroll dependent children in available employer-sponsored medical coverage, if required by a child support order. The Department of Labor develops and maintains the required Part B form (OMB #: 1210-0113) that employers use to inform a plan administrator that a participant is obligated by an order to provide health care coverage for dependent children. As part of the most recent revision request, ACF requested an implementation period and estimated burden for a one year implementation period. In reviewing the request in ROCIS, ACF has realized that burden was double counted by the way it was entered into the system. This request fixes that error.

US Code: 45 USC 303.32 Name of Law: National Medical Support Notice
   PL: Pub.L. 105 - 200 401(c) Section 609 Name of Law: Child Support Performance and Incentive Act
   US Code: 42 USC 666 Name of Law: Requirement of statutorily prescribed procedures to improve effectiveness of child supp enforcement
   US Code: 29 USC 1169 Name of Law: Additional standards for group health plans
  
None

Not associated with rulemaking

  90 FR 26818 06/24/2025
90 FR 44684 09/16/2025
Yes

5
IC Title Form No. Form Name
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - 2026 Forward 1 National Medical Support Notice Part A
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - Implementation Year 1 National Medical Support Notice Part A
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - 2026 Forward 1 National Medical Support Notice Part A
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) - Implementation Year 1 National Medical Support Notice Part A
National Medical Support Notice-Part A (Employer Respondents) - 2026 Forward 1 National Medical Support Notice Part A
National Medical Support Notice-Part A (Employer Respondents) - Implementation Year 1 National Medical Support Notice Part A
National Medical Support Notice-Part A (State Respondents) - 2026 Forward 1 National Medical Support Notice Part A
National Medical Support Notice-Part A (State Respondents) - Implementation Year 1 National Medical Support Notice Part A
State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year NMSN Matrix State Medical Support Contacts and Program Requirement Matrix

  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 9,512,998 19,181,513 0 -9,668,515 0 0
Annual Time Burden (Hours) 1,615,119 3,251,272 0 -1,636,153 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
In reviewing the request in ROCIS, ACF has realized that burden was double counted by the ICs were entered into the system. ACF would like to update the request to provide the average annual burden estimates accurately. To do so, a new burden table was added to Section A12 of SSA to summarize annual burden.

$332,060
No
    Yes
    No
No
No
No
No
Molly Buck 202 205-4724 [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.
05/29/2026