Model Employer CHIP Notice (Private Sector Burden)

Model Employer Children's Health Insurance Program Notice

OMB: 1210-0137

IC ID: 191695

Documents and Forms
Document Name
Document Type
Other-Model Notice
Information Collection (IC) Details

View Information Collection (IC)

Model Employer CHIP Notice (Private Sector Burden)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Model Notice chipmodelnotice 7-31-13.doc http://www.dol.gov/ebsa/chipmodelnotice.doc Yes Yes Fillable Fileable

Income Security General Retirement and Disability

 

5,961,000 38
   
Private Sector Businesses or other for-profits, Farms, Not-for-profit institutions
 
   38 %

  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 174,347,154 0 0 -29,447,846 0 203,795,000
Annual IC Time Burden (Hours) 900,519 0 0 -152,481 0 1,053,000
Annual IC Cost Burden (Dollars) 21,619,363 0 0 -3,651,637 0 25,271,000

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.

© 2024 OMB.report | Privacy Policy