Information Collection Request

Annual Report for Multiple Employer Welfare Arrangements

ICR 202206-1210-004 · OMB 1210-0116 · Received in OIRA

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 Repair queued
1210-0116 Form M-1 SS 6.28.22 Final.docx Supporting Statement A Uploaded 2022-06-28 Missing upstream

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
  Requested Previously Approved
36 Months From Approved 08/31/2022
719 572
1,839 120
0 111,377





table that charts list of burden
  Total Request 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 719 572 0 0 147 0
Annual Time Burden (Hours) 1,839 120 0 0 1,719 0
Annual Cost Burden (Dollars) 0 111,377 0 0 -111,377 0


Reginfo record details
  No