Information Collection

Additional Information Request to Plan Administrator

IC 189162 under ICR 201210-1210-002 · OMB 1210-0135.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 301 Additional Information Request to Plan Administrator	Form and Instruction
Form 301 Plan Sponsor/Plan Administrator Information Sheet Plan_Sponsor-Plan_Administrator_Information_Sheet41610[1].doc	Form and Instruction
EBSA301-E-1 Letter to ER2010.doc Plan Sponsor Information Sheet	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	Form 301	Plan Sponsor/Plan Administrator Information Sheet	Plan_Sponsor-Plan_Administrator_Information_Sheet41610[1].doc		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17

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: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	17	-1,383	1,400
Annual IC Time Burden (Hours)	4	-346	350
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.