OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Summary of Benefits and Coverage

IC 198888 under ICR 201304-1210-011 · OMB 1210-0147.

Documents and Forms
Document Name
Document Type
Other-Sample SBC
Instruction
Instruction
Other-SBC Sample Glossary
Other-SBC Yes Answers -- Why This Ma
Other-SBC - No Answers - Why This Ma
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Summary of Benefits and Coverage
 
No Modified
 
Mandatory
 
29 CFR 2590.715-2715

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Sample SBC SBC blank template 4-23-13 10am.doc Yes No Fillable Fileable
Instruction SBCInstructionsGroup[1].pdf Yes No Printable Only
Instruction SBCInstructionsIndividual.pdf Yes No Printable Only
Other-SBC Sample Glossary SBCUniformGlossary.pdf Yes No Printable Only
Other-SBC Yes Answers -- Why This Matters SBCYesAnswers.pdf Yes No Printable Only
Other-SBC - No Answers - Why This Matters SBCNoAnswers.pdf Yes No Printable Only

Health Consumer Health and Safety

 

858 274
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   44 %

  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 77,000,000 0 0 0 0 77,000,000
Annual IC Time Burden (Hours) 602,750 0 0 0 0 602,750
Annual IC Cost Burden (Dollars) 4,150,000 0 0 0 0 4,150,000

Title Document Date Uploaded
Sample Completed SBC SampleCompletedSBC 4-23-13 10am.doc 04/23/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.