Information Collection

Employer Appointment of Agent

IC 17366 under ICR 200806-1545-026 · OMB 1545-0748.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 2678
Employer Appointment of Agent
Form and Instruction
2678 Employer/Payer Appointment of Agent
Form 2678.pdf
Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 2678 Employer/Payer Appointment of Agent Form 2678.pdf No   Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 95,200 0 0 0 0 95,200
Annual IC Time Burden (Hours) 47,600 0 0 0 0 47,600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.