Information Collection

Payment of Premiums (29 CFR Part 4007), Disclosure to Participants (29 CFR Part 4011)

IC 13516 under ICR 200112-1212-002 · OMB 1212-0009.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0009 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Payment of Premiums (29 CFR Part 4007), Disclosure to Participants (29 CFR Part 4011)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	FORM-1-EZ	No	No
Form	FORM-1	No	No
Form	FORM-1-ES	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 37,700	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	45,900	-1,700	47,600
Annual IC Time Burden (Hours)	2,540	58	2,482
Annual IC Cost Burden (Dollars)	9,657,000	226,000	9,431,000

Documents for IC

Title	Document	Date Uploaded

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