Information Collection Request

Annual Report for Multiple Employer Welfare Arrangements

ICR 201904-1210-004 · OMB 1210-0116 · 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 ss19 4-17-2019.docx Supporting Statement A Uploaded 2019-04-18 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
08/31/2022 36 Months From Approved 07/31/2019
572 0 551
120 0 116
111,377 0 139,599





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 572 551 0 0 21 0
Annual Time Burden (Hours) 120 116 0 0 4 0
Annual Cost Burden (Dollars) 111,377 139,599 0 0 -28,222 0


Reginfo record details
  No