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 Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form EBSA 301 Plan Sponsor/Plan Administrator Information Sheet EBSA301-E-1 Letter to ER2010.doc Yes No Printable Only

Income Security General Retirement and Disability

 

1,400 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 1,400 0 0 0 0 1,400
Annual IC Time Burden (Hours) 350 0 0 0 0 350
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Plan Sponsor Information Sheet EBSA301-E-1 Letter to ER2010.doc 03/15/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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