Statement of Amendment of Employee Benefit Plan

ICR 199709-1545-010

OMB: 1545-1544

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
18667 Migrated
ICR Details
1545-1544 199709-1545-010
Historical Active 199706-1545-002
TREAS/IRS
Statement of Amendment of Employee Benefit Plan
Extension without change of a currently approved collection   No
Regular
Approved without change 10/22/1997
Retrieve Notice of Action (NOA) 09/10/1997
The agency is not required to display the expiration date.
  Inventory as of this Action Requested Previously Approved
10/31/2000 10/31/2000 12/31/1997
10,900 0 10,900
2,725 0 2,725
0 0 0

Form 11212 is part of a voluntary outreach program designed to ensure that retirement and pension plans are amended to conform to certain law changes. Completion of three questions on form 11212 indicates but does not guarantee that the plan document has been properly amended.

None
None


No

1
IC Title Form No. Form Name
Statement of Amendment of Employee Benefit Plan 11212

  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 10,900 10,900 0 0 0 0
Annual Time Burden (Hours) 2,725 2,725 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$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.
09/10/1997


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