Information Collection Request

EMPLOYER OR PAYER APPOINTMENT OF AGENT

ICR 198505-1545-006 · OMB 1545-0748 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
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IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
130565 EMPLOYER OR PAYER APPOINTMENT OF AGENT Form Migrated

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/1987 08/31/1987 04/30/1986
3,000 0 100
1,500 0 50
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
EMPLOYER OR PAYER APPOINTMENT OF AGENT 2678

table that charts list of burden
  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 3,000 100 0 2,900 0 0
Annual Time Burden (Hours) 1,500 50 0 1,450 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No