Notice to Employees of Coverage Options Under FLSA 18B (Private Sector)

Notice to Employees of Coverage Options Under Fair Labor Standards Act Section 18B

OMB: 1210-0149

IC ID: 206431

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Notice to Employees of Coverage Options Under FLSA 18B (Private Sector)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Model Notice model-notice-for-employers-who-offer-a-health-plan-to-some-or-all-employees.pdf Yes No Fillable Printable

Health Consumer Health and Safety

 

10,606,413 10,252,610
   
Private Sector Businesses or other for-profits, Farms, Not-for-profit institutions
 
   58 %

  Requested 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 26,966,621 0 0 -793,523 0 27,760,144
Annual IC Time Burden (Hours) 224,722 0 0 123,941 0 100,781
Annual IC Cost Burden (Dollars) 4,677,900 0 0 142,750 0 4,535,150

Title Document Date Uploaded
Instructions DOL TR 2013-02.pdf 04/10/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy