Information Collection Request

Multiple Employer Welfare Arrangement Administrative Law Judge Administrative Hearing Procedures

ICR 202502-1210-002 · OMB 1210-0148 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
1210-0148 ALJ ss 4-22-2025.docx Supporting Statement A Uploaded 2025-08-04 Available
1210-0148 ALJ ss 4-22-2025.docx Supporting Statement A Uploaded 2025-08-04 Missing upstream

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
198355 Multiple Employer Welfare Arrangement Administrative Law Judge Administrative Hearing Procedures Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2028 36 Months From Approved 09/30/2025
10 0 10
1,220 0 20
500 0 686,900





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1
table that charts list of burden
IC Title Form No. Form Name
Multiple Employer Welfare Arrangement Administrative Law Judge Administrative Hearing Procedures

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 10 10 0 0 0 0
Annual Time Burden (Hours) 1,220 20 0 0 1,200 0
Annual Cost Burden (Dollars) 500 686,900 0 0 -686,400 0


Reginfo record details
  No