Model Employer CHIP Notice

Model Employer CHIP Notice

OMB: 1210-0137

IC ID: 191695

Documents and Forms
Document Name
Document Type
Other-Model Notice
Information Collection (IC) Details

View Information Collection (IC)

Model Employer CHIP Notice
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Model Notice chipmodelnotice revisedclean.doc Yes Yes Fillable Fileable

Income Security General Retirement and Disability

 

7,056,000 0
   
Private Sector Businesses or other for-profits
 
   38 %

  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 203,795,000 0 0 0 0 203,795,000
Annual IC Time Burden (Hours) 1,053,000 0 0 0 0 1,053,000
Annual IC Cost Burden (Dollars) 25,271,000 0 0 0 0 25,271,000

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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