Information Collection

e-NMSN: Plan Administrator Profile

IC 250392 under ICR 202111-0970-004 · OMB 0970-0370.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0370 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 e-NMSN: Plan Administrator Profile	Form and Instruction
1 e-NMSN: Plan Administrator Profile 3- 0970-0370_e-NMSN Plan Administrator.pdf	Form and Instruction
1 e-NMSN: Plan Administrator Profile 3 - 0970-0370_e-NMSN Plan Administrator_Form_020422.pdf	Form and Instruction

IC Title:

e-NMSN: Plan Administrator Profile

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	e-NMSN: Plan Administrator Profile	3 - 0970-0370_e-NMSN Plan Administrator_Form_020422.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.