Information Collection

Administrative Appeals (Employers)

IC 46312 under ICR 201905-1212-010 · OMB 1212-0061.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0061 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Administrative Appeals (Employers)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 4003 Subpart D

Information Collection Instruments:

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

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3	-1	4
Annual IC Time Burden (Hours)	1	1	0
Annual IC Cost Burden (Dollars)	167	-2,733	2,900

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.