Calculation and Disclosure of Documentation of Eligibility for Exemption

Documents and Forms

Document Name Document Type
MHPANOTE TO REVIEWER.doc Note to Reviewer IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Calculation and Disclosure of Documentation of Eligibility for Exemption	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:

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 %

	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

Title	Document	Date Uploaded
Note to Reviewer	MHPANOTE TO REVIEWER.doc	11/29/2007

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