Information Collection

Grandfathered Plan Change in Carrier Disclosure

IC 195225 under ICR 202412-1210-001 · OMB 1210-0140.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Grandfathered Plan Change in Carrier Disclosure

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2590.715-1251(a)(1)

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: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19,656

Number of Respondents for Small Entity: 17,297

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
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	19,656	-19,655	39,311
Annual IC Time Burden (Hours)	655	0	655
Annual IC Cost Burden (Dollars)	82,619	1,540	81,079

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.

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