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

Documents and Forms

Document Name Document Type
Form Form 300 Request to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction Form and Instruction
Form 300 Application to U.S. Department of Labor for Expedited Re AARA COBRA.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 300	Application to U.S. Department of Labor for Expedited Review of Denial of COBRA Premium Reduction	AARA COBRA.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: 167	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 38 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	167	-13,833	14,000
Annual IC Time Burden (Hours)	167	-13,833	14,000
Annual IC Cost Burden (Dollars)	104	-7,896	8,000

Documents for IC

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.