National Medical Support Notice - Part A

Forms and Documents

Document Name	Status
Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year Form	Modified
2025-08-29 NMSN Part A Supporting Statement FINAL_9.12.25.docx Supporting Statement A	2025-09-12

IC Document Collections

IC ID	Document Title	Status
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	New
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	New
277534	National Medical Support Notice-Part A (Employer Respondents) - 2026 Forward Instruction	New
277533	National Medical Support Notice-Part A (State Respondents) - 2026 Forward Instruction	New
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	Modified
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	Modified
255976	State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year Form	Modified
236881	National Medical Support Notice-Part A (Employer Respondents) - Implementation Year Instruction	Modified
10060	National Medical Support Notice-Part A (State Respondents) - Implementation Year Instruction	Modified

ICR Details

OMB Control No: 0970-0222	ICR Reference No: 202509-0970-004
Status: Received in OIRA	Previous ICR Reference No: 202504-0970-026
Agency/Subagency: HHS/ACF	Agency Tracking No: OCSE
Title: National Medical Support Notice - Part A
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/16/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2025
Responses	19,181,513	9,771,527
Time Burden (Hours)	3,251,272	1,657,190
Cost Burden (Dollars)	0	0

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Abstract: 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. This request is for a revision to the currently approved information collection. Please see A.15 of Supporting Statement A for an explanation about the changes.

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Authorizing Statute(s): US Code: 29 USC 1169 Name of Law: Additional standards for group health plans
   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
  

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:
	90 FR 26818	06/24/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 44684	09/16/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 9

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

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ICR Summary of Burden

	Total Request	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	19,181,513	9,771,527	0	9,409,986	0	0
Annual Time Burden (Hours)	3,251,272	1,657,190	0	1,594,082	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: OCSE removed the State Medical Support Contacts and Program Requirement Matrix, which constitutes a program change. This change resulted in only a minimal overall reduction in burden costs because of an increase in employee wages. The overall burden hour was reduced due to a decrease in state responses and a decrease in the number of employer respondents. The time per response remains the same.

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Annual Cost to Federal Government: $332,060

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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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: 09/16/2025

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