Information Collection Request

Annual Report for Multiple Employer Welfare Arrangements

ICR 201810-1210-002 · 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 Repair queued
Justification for Nonmaterial Nonsubstantive Change 10-9-2018rocis.docx Justification for No Material/Nonsubstantive Change Uploaded 2018-10-11 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 06/30/2019 06/30/2019
551 0 456
116 0 97
139,599 0 81,900





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 551 456 0 0 95 0
Annual Time Burden (Hours) 116 97 0 0 19 0
Annual Cost Burden (Dollars) 139,599 81,900 0 0 57,699 0


Reginfo record details
  No