Employee Benefit Plan Claims Procedure Under ERISA

Forms and Documents

Document Name	Status
PRA 07 Claims SS-3.doc Supporting Statement A	0000-00-00

IC Document Collections

IC ID	Document Title	Status
13352	Employee Benefit Plan Claims Procedure Under ERISA	Modified

ICR Details

OMB Control No: 1210-0053	ICR Reference No: 200611-1210-006
Status: Historical Active	Previous ICR Reference No: 200401-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Employee Benefit Plan Claims Procedure Under ERISA
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/11/2007
	Date Received in OIRA: 02/22/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2010	36 Months From Approved	04/30/2007
Responses	320,999,996	0	18,000,000
Time Burden (Hours)	529,000	0	336,200
Cost Burden (Dollars)	423,051,994	0	90,582,000

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Abstract: ERISA Section 503 and regulations at 29 CFR 2560.503-1 require employee benefit plans to establish procedures for resolving benefit claims under the plan, including initial claims and appeal of denied claims. The regulation requires specific information to be disclosed at different stages of the claims process. It also requires claims denial notices to be provided within specific time frames and to include specific information.

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Authorizing Statute(s): US Code: 29 USC 1133 Name of Law: Employee Retirement Income Security Act of 1974
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 63784	10/31/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 8018	02/22/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Employee Benefit Plan Claims Procedure Under ERISA

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ICR Summary of Burden

	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	320,999,996	18,000,000	0	0	302,999,996	0
Annual Time Burden (Hours)	529,000	336,200	0	0	192,800	0
Annual Cost Burden (Dollars)	423,051,994	90,582,000	0	0	332,469,994	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: No program changes have been made since the previous submission. The changes in burden estimation are due to the use of updated information concerning the number of respondents and the frequency of claims. While the volume of claims has remained fairly stable over time, new research in health claims indicates that denial rates are much larger (15 percent as compared to 3 percent) and appeal rates are much lower (.2 percent as compared to 10 percent) than our earlier analyses assumed. In addition, new assumptions were made with regard to the share of denied claims appealed for medical versus administrative reasons (28.9 percent for medical versus 35.4 percent) based on new information. Assumptions pertaining to non-health claims made in the original analysis were largely retained, as no new information was available to refine. The exception to this was the share of covered workers filing short-term disability claims, which researchers indicated should be twice the previous assumption (6 percent as compared to 3 percent).

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/22/2007

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