Daily Rules, Proposed Rules, and Notices of the Federal Government


Office of the Secretary

Agency Information Collection Activities; Submission for OMB Review; Comment Request; Request to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction

ACTION: Notice.
SUMMARY: The Department of Labor (DOL) is submitting the Employee Benefits Security Administration (EBSA) sponsored information collection request (ICR) titled, "Request to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction," to the Office of Management and Budget (OMB) for review and approval for continued use in accordance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C. 3501 et seq.).
DATES: Submit comments on or before December 27, 2012.
ADDRESSES: A copy of this ICR with applicable supporting documentation; including a description of the likely respondents, proposed frequency of response, and estimated total burden may be obtained from the Web site,,on the day following publication of this notice or by contacting Michel Smyth by telephone at 202-693-4129 (this is not a toll-free number) or sending an email

Submit comments about this request to the Office of Information and Regulatory Affairs, Attn: OMB Desk Officer for DOL-EBSA, Office of Management and Budget, Room 10235, 725 17th Street NW., Washington, DC 20503, Fax: 202-395-6881 (this is not a toll-free number),

FOR FURTHER INFORMATION CONTACT: Contact Michel Smyth by telephone at 202-693-4129 (this is not a toll-free number) or by email

44 U.S.C. 3507(a)(1)(D).


American Recovery and Reinvestment Act of 2009 (ARRA) section 3001 provides an assistance eligible individual with the right to pay reduced health benefits premiums under the Consolidated Omnibus Budget Reconciliation Act of 1986, commonly called COBRA, for up to 9 months. If an individual requests treatment as an assistance eligible individual and is denied such treatment because of COBRA continuation coverage ineligibility, ARRA section 3001(a)(5) requires the Secretary of Labor to provide for expedited review of the denial upon application to the Secretary in the form and manner the Secretary provides. The Secretary of Labor is required to act in consultation with the Secretary of the Treasury and must make a determination within 15 business days after receipt of an individual's application for review. The Application to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction is the form used by individuals to file their expedited review appeals. Such individuals must complete all information requested on the Application in order to file their review requests with the EBSA. The ICR relates to the Application.

This information collection is subject to the PRA. A Federal agency generally cannot conduct or sponsor a collection of information, and the public is generally not required to respond to an information collection, unless it is approved by the OMB under the PRA and displays a currently valid OMB Control Number. In addition, notwithstanding any other provisions of law, no person shall generally be subject to penalty for failing to comply with a collection of information if the collection of information does not display a valid Control Number.See5 CFR 1320.5(a) and 1320.6. The DOL obtains OMB approval for this information collection under Control Number 1210-0135. The current approval is scheduled to expire on November 30, 2012; however, it should be noted that existing information collection requirements submitted to the OMB receive a month-to-month extension while they undergo review. For additional information, see the related notice published in theFederal Registeron June 25, 2012 (77 FR 37920).

Interested parties are encouraged to send comments to the OMB, Office of Information and Regulatory Affairs at the address shown in theADDRESSESsection within 30 days of publication of this notice in theFederal Register. In order to help ensure appropriate consideration, comments should mention OMB Control Number 1210-0135. The OMB is particularly interested in comments that:

• Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility;

• Evaluate the accuracy of the agency's estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used;

• Enhance the quality, utility, and clarity of the information to be collected; and

• Minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses.


Title of Collection:Request to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction.

OMB Control Number:1210-0135.

Affected Public:Individuals or Households and Private Sector—businesses or other for-profits and not-for-profit institutions.

Total Estimated Number of Respondents:184.

Total Estimated Number of Responses:184.

Total Estimated Annual Burden Hours:171.

Total Estimated Annual Other Costs Burden:$104.

Dated: November 20, 2012. Michel Smyth, Departmental Clearance Officer.