Employee Benefits Security Administration Health Benefits Education Outreach Survey

Department of Labor Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0088 can be found here:

Documents and Forms

Document Name Document Type
HBEC SURVEY(2014).pdf Other-Web-based survey
HBEC Survey clearance form 2014.pdf Supplemental Justification Supporting Statement for Employee Benefits Security Administration Health Benefits Education Outreach IC Document

Information Collection (IC) Details

IC Title:	Employee Benefits Security Administration Health Benefits Education Outreach Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web-based survey			HBEC SURVEY(2014).pdf		No		Paper Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supplemental Justification Supporting Statement for Employee Benefits Security Administration Health Benefits Education Outreach Survey	HBEC Survey clearance form 2014.pdf	06/29/2014

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