Furnishing Documents to the Secretary of Labor on Request under ERISA section 104(a)(6)

ICR 200210-1210-004

OMB: 1210-0112

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
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ICR Details
1210-0112 200210-1210-004
Historical Active 200204-1210-002
DOL/EBSA
Furnishing Documents to the Secretary of Labor on Request under ERISA section 104(a)(6)
Extension without change of a currently approved collection   No
Regular
Approved without change 12/24/2002
Retrieve Notice of Action (NOA) 10/28/2002
  Inventory as of this Action Requested Previously Approved
12/31/2005 12/31/2005 12/31/2002
1,000 0 1,000
95 0 95
4,000 0 4,000

ERISA section 104(a)(6) and related regulations at 29 CFR 2520. 104a-8 require the administrator of an employee benefit plan covered by Title I of ERISA to furnish certain documents relating to the plan on request to the Secretary of Labor.

None
None


No

1
IC Title Form No. Form Name
Furnishing Documents to the Secretary of Labor on Request under ERISA section 104(a)(6)

  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 1,000 1,000 0 0 0 0
Annual Time Burden (Hours) 95 95 0 0 0 0
Annual Cost Burden (Dollars) 4,000 4,000 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.
10/28/2002


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