Annual Report for Multiple Employer Welfare Arrangements (Form M-1)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form M-1 Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)	Form and Instruction	Modified	Available
1210-0116-SSPRA-06.doc	Supporting Statement A	Uploaded 2006-12-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13484	Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)	Form and Instruction	Modified

ICR Details

OMB Control No: 1210-0116	ICR Reference No: 200610-1210-002
Status: Historical Active	Previous ICR Reference No: 200311-1210-002
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Annual Report for Multiple Employer Welfare Arrangements (Form M-1)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/20/2007
	Date Received in OIRA: 01/10/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	36 Months From Approved	02/28/2007
Responses	515	0	3,718
Time Burden (Hours)	78	0	564
Cost Burden (Dollars)	45,520	0	349,000

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Abstract: The Department's regulation at 29 CFR 2520.101-2 requires annual reporting by "multiple employer welfare arrangements," as defined in section 3(40) of ERISA, and certain other entities claiming an exception from the ERISA definition of "multiple employer welfare arrangements," for the purpose of determining the extent to which such entities comply with Part 7 of ERISA. The Department provides a form (Form M-1) for the required reporting and also provides an electronic filing system through which entities may complete the required Form M-1 and file it without cost.

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Authorizing Statute(s): US Code: 29 USC 1021(g) Name of Law: ERISA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 63783	10/31/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 1243	01/10/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)	Form M-1	2006 Form M-1 for Multiple Employee Welfare Arrangements (MEWAs) and Certain Entities Claiming Exception (ECEs)

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ICR Summary of Burden

table that charts list of burden

	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	515	3,718	0	0	-3,203	0
Annual Time Burden (Hours)	78	564	0	0	-486	0
Annual Cost Burden (Dollars)	45,520	349,000	0	0	-303,480	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There have been no program changes to this information collections. The burden estimates have been revised based on recent data regarding the actual number of 2005 Form M-1 filings. In addition, the Department has corrected an error in the prior ICR which assumed that a MEWA or ECE would file a separate M-1 for each ERISA-covered employee benefit plan under which it provided benefits. These two changes result in a decrease in the number of respondents and responses from 3,718 to 515. In addition, the Department has updated its assumptions regarding wage rates and the availability of the Form M-1 electronic filing system. These changes have also resulted in a reduction in burden estimates, from 564 hours to 78 hours annually and from $349,000 to $45,520 annually.

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Annual Cost to Federal Government: $9,900

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/10/2007

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