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Additional Information to Be Shared with the Initial Payment or Notice of Denial of Payment
Additional Information to Be Shared with the Initial Payment or Notice of Denial of Payment
OMB: 1210-0169
OMB.report
DOL/EBSA
OMB 1210-0169
ICR 202302-1210-003
IC 254938
Additional Information to Be Shared with the Initial Payment or Notice of Denial of Payment
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⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1210-0169 can be found here:
2023-11-03 - Revision of a currently approved collection
2023-02-24 - RCF Recertification
Document [docx]
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File Type
application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author
Khan, Mariam - EBSA
File Modified
0000-00-00
File Created
2023-09-20
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