Information Collection

Notice of Failure to Make Required Contributions

IC 13573 under ICR 200212-1212-001 · OMB 1212-0041.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0041 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Notice of Failure to Make Required Contributions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	200				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30	5	25
Annual IC Time Burden (Hours)	64	22	42
Annual IC Cost Burden (Dollars)	12,000	6,000	6,000

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.