Information Collection

Calculation and Disclosure of Documentation of Eligibility for Exemption

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

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.