IDR Entity Certification and IDR Entity Monthly Reporting

No Surprise Act: IDR Process

OMB: 1210-0169

IC ID: 252196

Documents and Forms
Document Name
Document Type
Other-IDR Certification Application
Other-Notice of Petition for Denial
Other-Monthly IDR Entity Reporting R
Other-Notice of IDR Payment Determin
Information Collection (IC) Details

View RCF Information Collection (IC)

IDR Entity Certification and IDR Entity Monthly Reporting
 
New
 
Mandatory
 
29 CFR 2590

Document Type Form No. Form Name Instrument File URL 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

Income Security General Retirement and Disability

 

13 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 85 85 0 0 0 0
Annual IC Time Burden (Hours) 0 0 0 0 0 0
Annual IC Cost Burden (Dollars) 22,135 22,135 0 0 0 0

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