Information Collection Request

Payment of Premiums (29 CFR part 4007)

ICR 201910-1212-005 · OMB 1212-0009 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
2020 Supporting Statement 1212-0009.03.docx Supporting Statement A Uploaded 2019-10-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
13518 Payment of Premiums (29 CFR part 4007) Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2022 36 Months From Approved 06/30/2021
31,245 0 23,700
13,540 0 10,439
21,621,540 0 16,392,500





Reginfo record details
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table that charts list of burden
IC Title Form No. Form Name
Payment of Premiums (29 CFR part 4007)

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 31,245 23,700 0 0 7,545 0
Annual Time Burden (Hours) 13,540 10,439 0 0 3,101 0
Annual Cost Burden (Dollars) 21,621,540 16,392,500 0 0 5,229,040 0


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