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###### Department of Labor

###### Office of the Secretary 

                    The Department of Labor (DOL) has submitted the following public information collection request (ICR) to the Office of Management and Budget (OMB) for review and approval in accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. chapter 35). A copy of this ICR, with applicable supporting documentation, may be obtained by contacting Darrin King on (202) 693-4129 (this is not a toll-free number) or e-mail:                     *king.darrin@dol.gov*.                 

                    Comments should be sent to Office of Information and Regulatory Affairs, Attn: OMB Desk Officer for the Employee Benefits Security Administration (EBSA), Office of Management and Budget, Room 10235, Washington, DC 20503, (202) 395-7316 (this is not a toll-free number), within 30 days from the date of this publication in the                     **Federal Register**                    .                 

The OMB is particularly interested in comments which:
    - 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.                 

*Agency:*                     Employee Benefits Security Administration.                 

*Type of Review:*                     Extension of currently approved collection.                 

*Title:*                     Calculation and Disclosure of Documentation of Eligibility for Exemption.                 

*OMB Number:*                     1210-0106.                 

*Frequency:*                     On occasion.                 

*Type of Response:*                     Recordkeeping and Third party disclosure.                 

*Affected Public:*                     Business or other for-profit; Individuals or households; and Not-for-profit institutions.                 

*Number of Respondents:*                     10.                 

*Number of Annual Responses:*                     200.                 

*Estimated Time Per Response:*                     3 minutes.                 

*Total Burden Hours:*                     10 hours.                 

*Total Annualized capital/startup costs:*                     $0.                 

*Total Annual Costs (operating/maintaining systems or purchasing services):*                     $100.                 

*Description:*                     Under 29 CFR 2590.712(f)(2), a group health plan wishing to elect the one percent exemption must calculate their increased costs according to certain rules, maintain group health plan claims and administrative expense records in such a way that they can be used to demonstrate the applicability of the one percent cost increase exemption as defined in the interim final rules, and that a summary of that information can be provided at the request of participants and beneficiaries, or their representative at no charge.                 

Group health plans use this information to obtain the benefits of the exemption from the requirement that they provide for parity between mental health benefits and medical/surgical benefits. Participants and beneficiaries use the information to be informed of the benefits available to them under their group health plans, and to verify or dispute the applicability of the exemption which may serve to limit benefits which would otherwise be available to them. 

Ira L. Mills, 

Departmental Clearance Officer. 

[FR Doc. 04-24659 Filed 11-3-04; 8:45 am] 

BILLING CODE 4510-23-P