Information Collection

Additional Information Request to Plan Administrator

IC 189162 under ICR 200903-1210-002 · OMB 1210-0135.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0135 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EBSA Form 301 Additional Information Request to Plan Administrator	Form and Instruction
EBSA Form 301 Request for Additonal Information from Plan Administrato Letter E Request for info to PA-May 14[1].doc	Form and Instruction

IC Title:

Additional Information Request to Plan Administrator

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	EBSA Form 301	Request for Additonal Information from Plan Administrator	Letter E Request for info to PA-May 14[1].doc		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	9,500	9,500
Annual IC Time Burden (Hours)	4,750	4,750
Annual IC Cost Burden (Dollars)	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.