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Notice to Participants and Beneficiaries and the Federal Government of Electing One Percent Increased Cost Exemption
Notice to Participants and Beneficiaries and the Federal Government of Electing One Percent Increased Cost Exemption
OMB: 1210-0105
IC ID: 13456
OMB.report
DOL/EBSA
OMB 1210-0105
ICR 200411-1210-001
IC 13456
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0105 can be found here:
2007-12-04 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Notice to Participants and Beneficiaries and the Federal Government of 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
Federal Enterprise Architecture Business Reference Module
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
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
10,000
0
0
0
0
10,000
Annual IC Time Burden (Hours)
333
0
0
0
0
333
Annual IC Cost Burden (Dollars)
5,000
0
0
0
0
5,000
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.