Information Collection

Employee Benefits Security Administration Health Benefits Education Outreach Survey

IC 212160 under ICR 201406-1225-002 · OMB 1225-0088.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.