Request for Assistance from the Department of Labor, Employee Benefits Security Administration

ICR 201407-1210-002

OMB: 1210-0146

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2014-09-16
IC Document Collections
IC ID
Document
Title
Status
198333 Modified
ICR Details
1210-0146 201407-1210-002
Historical Active 201106-1210-001
DOL/EBSA
Request for Assistance from the Department of Labor, Employee Benefits Security Administration
Extension without change of a currently approved collection   No
Regular
Approved without change 10/30/2014
Retrieve Notice of Action (NOA) 09/24/2014
  Inventory as of this Action Requested Previously Approved
10/31/2017 36 Months From Approved 10/31/2014
6,500 0 30,000
3,250 0 15,000
0 0 3,100

EBSA assists participants in understanding their rights, responsibilities, and benefits under employee benefit law and intervenes informally on their behalf with the plan sponsor in order to assist them in obtaining the health and retirement benefits to which they may have been inappropriately denied, which can avert the necessity for a formal investigation or a civil action. EBSA has made a request for assistance form available on its Web site for those wishing to obtain assistance in this manner.

None
None

Not associated with rulemaking

  79 FR 29208 05/21/2014
79 FR 57133 09/24/2014
No

  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 6,500 30,000 0 0 -23,500 0
Annual Time Burden (Hours) 3,250 15,000 0 0 -11,750 0
Annual Cost Burden (Dollars) 0 3,100 0 0 -3,100 0
No
No
The burden estimates are lower than during the last submission. In the case of the hour burden, the Department made projections on the use of the new form that turned out to be too high. Actual usage was lower than projected, and has been adjusted accordingly for this submission. Further, the Department expected to receive 15 percent of its inquiries through the mail and calculated the cost burden accordingly. In actuality, none of its inquiries were received through the mail, and the Department sees no reason why this will change in the future. The cost to the government has decreased because the costs included in the last submission reflected one-time start-up costs that are no longer applicable for this renewal.

$0
No
No
No
No
No
Uncollected
Christopher Cosby 202-693-8425 cosby.chris@dol.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/24/2014


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