Information Collection Request
Opt-in State Balance Bill Process
ICR 202411-1210-002 · OMB 1210-0168 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 1210-0168 State Opt-in Balance Bill Process 3-21-2025.docx |
Supporting Statement A | Uploaded 2025-03-21 | Repair queued |
 No-Surprises-Act (1).pdf |
Supplementary Document | Uploaded 2021-08-24 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 248996 |  Opt-In State Balance Bill Process |
Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOL/EBSA |
| OMB Control No | 1210-0168 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202202-1210-004 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |