Additional Information Request to Plan Administrator

Request to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction

OMB: 1210-0135

IC ID: 189162

Information Collection (IC) Details

View Information Collection (IC)

Additional Information Request to Plan Administrator
 
No New
 
Voluntary
 

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

Income Security General Retirement and Disability

 

9,500 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 9,500 9,500 0 0 0 0
Annual IC Time Burden (Hours) 4,750 4,750 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy