Information Collection

Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)

IC 13484 under ICR 201002-1210-002 · OMB 1210-0116.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0116 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form M-1 Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)	Form and Instruction
M-1 Report for Multiple Employer Welfare Arranagement and Ce 2009M1Package.pdf www.dol.gov/ebsa/pdf/2009M1Package.pdf	Form and Instruction

IC Title:

Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2520.101-2

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	M-1	Report for Multiple Employer Welfare Arranagement and Certain Entities Claiming Exception	2009M1Package.pdf	http://www.dol.gov/ebsa/pdf/2009M1Package.pdf	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 464

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: 44 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	464	-51	515
Annual IC Time Burden (Hours)	62	-16	78
Annual IC Cost Burden (Dollars)	44,000	-1,520	45,520

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.