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

Annual Report for Multiple Employer Welfare Arrangements

⚠️ Notice: This information collection may be referencing outdated material.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 Form M-1 Annual Report for Multiple Employer Welfare Arrangements and Certain Entities Claiming Exception (Form M-1) Form and Instruction
APPENDIX D.docx Other-Proposed Changes To 2022 Form
APPENDIX D.docx Other-Proposed Changes To 2022 Form
Form M-1 Report for Multiple Employer Welfare Arrangements (MEWAs Form M-1.pdf Form and Instruction
Form M-1 Report for Multiple Employer Welfare Arrangements (MEWAs Form M-1.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	Form M-1	Report for Multiple Employer Welfare Arrangements (MEWAs) and Certain Entitiies Claiming Exception (ECEs)	Form M-1.pdf		Yes	Yes	Fillable Fileable
Other-Proposed Changes To 2022 Form M-1 And Instructions			APPENDIX D.docx		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: 687	Number of Respondents for Small Entity: 55

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	687	0	115	572
Annual IC Time Burden (Hours)	175	55	0	120
Annual IC Cost Burden (Dollars)	163,459	52,082	0	111,377

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.