IDR Entity Certification and IDR Entity Monthly Reporting

No Surprises Act: IDR Process

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0169 can be found here:

Documents and Forms

Document Name Document Type
7. Tri-dept - IDR certification application (data elements) clean 9.28.21.docx Other-IDR Certification Application
8. Tri-dept - notice of petition for certification denial or revocation clean 9.28.21.docx Other-Notice of Petition for Denial
9. Tri-dept - monthly IDR entity reporting requirements (data elements) clean 9.28.21.docx Other-Monthly IDR Entity Reporting R
11. Tri-dept - Certified IDR Entity Written Determination (Data Elements) clean 9.28.21.docx Other-Notice of IDR Payment Determin

Information Collection (IC) Details

IC Title:	IDR Entity Certification and IDR Entity Monthly Reporting	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-IDR Certification Application	7. Tri-dept - IDR certification application (data elements) clean 9.28.21.docx	Yes	Yes	Fillable Printable
Other-Notice of Petition for Denial or Revocation	8. Tri-dept - notice of petition for certification denial or revocation clean 9.28.21.docx	Yes	Yes	Fillable Printable
Other-Monthly IDR Entity Reporting Requirements	9. Tri-dept - monthly IDR entity reporting requirements (data elements) clean 9.28.21.docx	Yes	Yes	Fillable Printable
Other-Notice of IDR Payment Determination	11. Tri-dept - Certified IDR Entity Written Determination (Data Elements) clean 9.28.21.docx	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	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: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	85	85
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	22,135	22,135

Documents for IC

Title	Document	Date Uploaded
No associated records found

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