Information Collection Request

Annual Report for Multiple Employer Welfare Arrangements

ICR 201602-1210-001 · OMB 1210-0116 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form M-1 Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1) Form and Instruction Modified Available
1210-0116 ss16.docx Supporting Statement A Uploaded 2016-02-18 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
13484 Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2019 36 Months From Approved 06/30/2016
456 0 484
95 0 130
81,900 0 91,996





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1) Form M-1 Report for Multiple Employer Welfare Arrangements (MEWAs) and Certain Entities Claiming Exception (ECEs)

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 456 484 0 0 -28 0
Annual Time Burden (Hours) 95 130 0 0 -35 0
Annual Cost Burden (Dollars) 81,900 91,996 0 0 -10,096 0


Reginfo record details
  No