Glossary

Summary of Benefits and Coverage and Uniform Glossary Required Under the Affordable Care Act

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0147 can be found here:

Documents and Forms

Document Name Document Type
sbc-uniform-glossary-of-coverage-and-medical-terms-new.pdf www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits Other-Uniform Glossary- November 201
sbc-uniform-glossary-of-coverage-and-medical-terms-new.pdf www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits Other-Uniform Glossary- November 201
Uniform-Glossary-11-2019-v2.pdf Uniform Glossary-November 2019 IC Document
Uniform-Glossary-11-2019-v2.pdf Uniform Glossary-November 2019 IC Document

Information Collection (IC) Details

IC Title:	Glossary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.715-2715

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Uniform Glossary- November 2019			sbc-uniform-glossary-of-coverage-and-medical-terms-new.pdf	https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits	Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,007,298	Number of Respondents for Small Entity: 1,627,758

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 58 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,627,758	101,408	1,526,350
Annual IC Time Burden (Hours)	13,565	845	12,720
Annual IC Cost Burden (Dollars)	634,826	62,445	572,381

Documents for IC

Title	Document	Date Uploaded
Uniform Glossary-November 2019	Uniform-Glossary-11-2019-v2.pdf	12/10/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.