Information Collection

Notice of Revocation of Accommodation

IC 228285 under ICR 202407-1210-002 · OMB 1210-0150.

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IC Title:

Notice of Revocation of Accommodation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 2590.715-2713A 29 CFR 2510.3-16

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 109

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 58 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-182,051	182,051
Annual IC Time Burden (Hours)	-109	109
Annual IC Cost Burden (Dollars)	-45,658	45,658

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table that charts IC Documents
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