Information Collection

Notice to Participants and Beneficiaries and the Federal Government to Electing one Percent Increased Cost Exemption

IC 13455 under ICR 200108-1210-003 · OMB 1210-0105.

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IC Title:

Notice to Participants and Beneficiaries and the Federal Government to Electing one Percent Increased Cost Exemption

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10,000	-84,854	94,854
Annual IC Time Burden (Hours)	333	-2,829	3,162
Annual IC Cost Burden (Dollars)	5,000	-265,000	270,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.