Request for Assistance from the Department of Labor, Employee Benefits Security Administration

ICR 201708-1210-002

OMB: 1210-0146

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2017-10-20
IC Document Collections
IC ID
Document
Title
Status
198333 Modified
ICR Details
1210-0146 201708-1210-002
Active 201407-1210-002
DOL/EBSA
Request for Assistance from the Department of Labor, Employee Benefits Security Administration
Extension without change of a currently approved collection   No
Regular
Approved without change 01/05/2018
Retrieve Notice of Action (NOA) 10/30/2017
  Inventory as of this Action Requested Previously Approved
01/31/2021 36 Months From Approved 01/31/2018
7,618 0 6,500
3,809 0 3,250
0 0 0

EBSA assists participants in understanding their rights, responsibilities, and benefits under employee benefit law and intervenes informally on their behalf with the plan sponsor in order to assist them in obtaining the health and retirement benefits to which they may have been inappropriately denied, which can avert the necessity for a formal investigation or a civil action. EBSA has made a request for assistance form available on its Web site for those wishing to obtain assistance in this manner.

US Code: 29 USC 1143 Name of Law: ERISA Section 513
   US Code: 29 USC 1134 Name of Law: ERISA Section 504
  
None

Not associated with rulemaking

  82 FR 23303 05/22/2017
82 FR 50165 10/30/2017
No

  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 7,618 6,500 0 0 1,118 0
Annual Time Burden (Hours) 3,809 3,250 0 0 559 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The hour burden and monetized equivalent cost has been adjusted to reflect updated information on the number of web requests and labor costs.

$1,500
No
    No
    No
No
No
No
Uncollected
Allan Beckmann 202 693-8429 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/30/2017


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