Information Collection

Multiple Employer Welfare Arrangements Revisions of Form 5500

IC 205399 under ICR 201411-1210-007 · OMB 1210-0110.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0110 can be found here:

Documents and Forms

Document Name Document Type
Form Form 5500 Multiple Employer Welfare Arrangements Revisions of Form 5500 Form and Instruction
Form 5500 Annual Return/Report of Employee Benefit Plans MEWA Final Rule FRN.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Multiple Employer Welfare Arrangements Revisions of Form 5500	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2520.103-1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 5500	Annual Return/Report of Employee Benefit Plans	MEWA Final Rule FRN.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	21,600	21,600

Documents for IC

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