Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)

Annual Report for Multiple Employer Welfare Arrangements (Form M-1)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0116 can be found here:

Documents and Forms

Document Name Document Type
Form M-1 Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1) Form and Instruction
M-1 Annual Report for Multiple Employer Welfare Arrangements Deliberative Document Place Holder.docx www.dol.gov/ebsa/pdf/2009M1Package.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2520.101-2

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	M-1	Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1)	Deliberative Document Place Holder.docx	http://www.dol.gov/ebsa/pdf/2009M1Package.pdf	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: 484	Number of Respondents for Small Entity: 258

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	484	19	1	464
Annual IC Time Burden (Hours)	130	65	3	62
Annual IC Cost Burden (Dollars)	91,996	45,596	2,400	44,000

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.