Information Collection

Multiple Employer Welfare Arrangement Administrative Law Judge Administrative Hearing Procedures

IC 198355 under ICR 201904-1210-003 · OMB 1210-0148.

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Information Collection (IC) Details

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IC Title:	Multiple Employer Welfare Arrangement Administrative Law Judge Administrative Hearing Procedures	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 2571.3

Information Collection Instruments:

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

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 6

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10	0	10
Annual IC Time Burden (Hours)	20	0	20
Annual IC Cost Burden (Dollars)	668,900	73,200	595,700

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