SIMPLIFIED ANNUAL REPORT FORMAT

ICR 198012-1210-003

OMB: 1210-0017

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
121467 Migrated
ICR Details
1210-0017 198012-1210-003
Historical Active 197901-1210-004
DOL/EBSA
SIMPLIFIED ANNUAL REPORT FORMAT
Revision of a currently approved collection   No
Regular
Approved without change 02/17/1981
Retrieve Notice of Action (NOA) 12/19/1980
Request for extension of this approval shall provide a more complete explanation of the basis of the burden estimate.
  Inventory as of this Action Requested Previously Approved
12/31/1983 12/31/1983 12/31/1980
5,000 0 5,000
417 0 833
0 0 0

ON APRIL 9, 1976, A NOTICE OF PROPOSED AMENDMENTS TO 29CFR 403.4(B) WAS PUBLISHED TO PROVIDE FOR SIMPLIFIED REPORTING UNDER THE LMRDA FOR LOCAL UNIONS WHICH ARE NOT IN TRUSTEESHIP, HAVE NO ASSETS, LIABILITIES, RECEIPTS AND DISBURSEMENTS AND MEET OTHER SPECIFIED CONDITIONS.

None
None


No

1
IC Title Form No. Form Name
SIMPLIFIED ANNUAL REPORT FORMAT LMSA-SAR-1

  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 5,000 5,000 0 0 0 0
Annual Time Burden (Hours) 417 833 0 -416 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/19/1980


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