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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Information Collection (IC) Details

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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:

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 %

	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

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