OMB
.report
Search
Calculation and Disclosure of Documentation of Eligibility for Exemption
Calculation and Disclosure of Documentation of Eligibility for Exemption
OMB: 1210-0106
IC ID: 13460
OMB.report
DOL/EBSA
OMB 1210-0106
ICR 200711-1210-004
IC 13460
( )
Documents and Forms
Document Name
Document Type
MHPANOTE TO REVIEWER.doc
Note to Reviewer
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Calculation and Disclosure of Documentation of Eligibility for Exemption
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
29 CFR 2590.712
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
200
0
0
0
0
200
Annual IC Time Burden (Hours)
110
0
0
100
0
10
Annual IC Cost Burden (Dollars)
216
0
0
216
0
0
Documents for IC
Title
Document
Date Uploaded
Note to Reviewer
MHPANOTE TO REVIEWER.doc
11/29/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.