Model Employer CHIP Notice

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0137 can be found here:

Documents and Forms

Document Name Document Type
chipmodelnotice revisedclean.doc Other-Model Notice

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Model Employer CHIP Notice	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Model Notice			chipmodelnotice revisedclean.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,056,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 38 %

	Approved	Previously Approved
Annual Number of Responses for this IC	203,795,000	203,795,000
Annual IC Time Burden (Hours)	1,053,000	1,053,000
Annual IC Cost Burden (Dollars)	25,271,000	25,271,000

Documents for IC

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.