Information Collection

HRA Notice to Participants and other disclosures

IC 233410 under ICR 201810-1210-001 · OMB 1210-0160.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0160 can be found here:

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Information Collection (IC) Details

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IC Title:	HRA Notice to Participants and other disclosures	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.702-2

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 678,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 54 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,782,690	8,782,690
Annual IC Time Burden (Hours)	196,991	196,991
Annual IC Cost Burden (Dollars)	37,569	37,569

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