Information Collection

Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)

IC 13484 under ICR 200610-1210-002 · OMB 1210-0116.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0116 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form M-1 Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)	Form and Instruction
Form M-1 2006 Form M-1 for Multiple Employee Welfare Arrangements 2006M1Form.pdf	Form and Instruction
FRN Pub M-1 Form 06.pdf Federal Register Notice of Availability of 2006 Form M-1	IC Document

IC Title:

Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2520.101-2

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form M-1	2006 Form M-1 for Multiple Employee Welfare Arrangements (MEWAs) and Certain Entities Claiming Exception (ECEs)	2006M1Form.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 515

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 44 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	515	-3,203	3,718
Annual IC Time Burden (Hours)	78	-486	564
Annual IC Cost Burden (Dollars)	45,520	-303,480	349,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Federal Register Notice of Availability of 2006 Form M-1	FRN Pub M-1 Form 06.pdf	01/05/2007

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