Information Collection Request

Annual Report for Multiple Employer Welfare Arrangements

ICR 202412-1210-005 · OMB 1210-0116 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form M-1 Report for Multiple Employer Welfare Arrangements (MEWAs) and Certain Entitiies Claiming Exception (ECEs) Form and Instruction Modified Available
Form Form M-1 Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1) Form and Instruction Modified Missing upstream
Form M1 - No Material-Nonsubstantive Change SCA-12182024.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-12-20 Available
Form M1 - No Material-Nonsubstantive Change SCA-12182024.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-12-20 Repair queued
1210-0116 Form M-1 SS 6.28.22 Final.docx Supporting Statement A Uploaded 2022-06-28 Available
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 ModifiedReport for Multiple Employer Welfare Arrangements (MEWAs) and Certain Entitiies Claiming Exception (ECEs)
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
  Inventory as of this Action Requested Previously Approved
08/31/2025 08/31/2025 08/31/2025
719 0 719
1,839 0 1,839
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1) Form M-1

table that charts list of burden
  Total Approved 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 719 719 0 0 0 0
Annual Time Burden (Hours) 1,839 1,839 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No