Information Collection

Notice to Employees of Coverage Options under FLSA 18B

IC 206431 under ICR 201304-1210-005 · OMB 1210-0149.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0149 can be found here:

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Information Collection (IC) Details

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IC Title:	Notice to Employees of Coverage Options under FLSA 18B	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,160,461	Number of Respondents for Small Entity: 5,800,000

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 38 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	72,484,292	72,484,292
Annual IC Time Burden (Hours)	374,502	374,502
Annual IC Cost Burden (Dollars)	12,229,992	12,229,992

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