Information Collection

Multiple Employer Welfare Arrangements Revisions of Form 5500

IC 205399 under ICR 201305-1210-002 · OMB 1210-0110.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0110 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 5500 Multiple Employer Welfare Arrangements Revisions of Form 5500	Form and Instruction
Form 5500 Annual Return/Report of Employee Benefit Plans Place holder for Deliberative Document.docx	Form and Instruction

IC Title:

Multiple Employer Welfare Arrangements Revisions of Form 5500

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2520.103-1

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 5500	Annual Return/Report of Employee Benefit Plans	Place holder for Deliberative Document.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	21,600	21,600

Documents for IC

table that charts IC Documents
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.