Information Collection Request

Employer Appointment of Agent

ICR 200806-1545-026 · OMB 1545-0748 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 2678 Employer Appointment of Agent Form and Instruction Modified Available
ombat2.doc Supplementary Document Uploaded 2008-06-24 Available
2678.Sup.doc Supporting Statement A Uploaded 2008-06-24 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
17366 Employer Appointment of Agent Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2011 36 Months From Approved 10/31/2008
95,200 0 95,200
47,600 0 47,600
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Employer Appointment of Agent 2678 Employer/Payer Appointment of Agent

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 95,200 95,200 0 0 0 0
Annual Time Burden (Hours) 47,600 47,600 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No