Information Collection

Calculation and Disclosure of Documentation of Eligibility for Exemption

IC 13460 under ICR 200711-1210-004 · OMB 1210-0106.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
MHPANOTE TO REVIEWER.doc Note to Reviewer	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 2590.712

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

Line of Business: Income Security

Subfunction: General Retirement and Disability

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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200	0	200
Annual IC Time Burden (Hours)	110	100	10
Annual IC Cost Burden (Dollars)	216	216	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer		11/29/2007

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

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