Information Collection Request

Employer Appointment of Agent

ICR 201103-1545-016 · OMB 1545-0748 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 2678 Employer / Payer Appointment of Agent Form and Instruction Modified Available
Summary of Changes_11f2678.pdf Justification for No Material/Nonsubstantive Change Uploaded 2011-03-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
17366 Employer / Payer Appointment of Agent Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2011 11/30/2011 11/30/2011
6,130,000 0 95,200
13,731,200 0 47,600
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Employer / Payer Appointment of Agent 2678 Employer/Payer Appointment of Agent

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 6,130,000 95,200 0 6,034,800 0 0
Annual Time Burden (Hours) 13,731,200 47,600 0 13,647,424 36,176 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No