OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Request for Assistance from the Department of Labor, Employee Benefits Security Administration

ICR 202207-1210-002 · OMB 1210-0146 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 301 Customer Service Intake Form Form and Instruction Unchanged Available
1210-0146 Online inquiry form nonsubstantive change July 2022 Final.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-07-15 Repair queued
page 4 Screenshot 2022-07-15 100647.png Supplementary Document Uploaded 2022-07-15 Repair queued
inquiry form page 3 part 2 Screenshot 2022-07-15 100406.png Supplementary Document Uploaded 2022-07-15 Repair queued
inquiry form page 3 Screenshot 2022-07-15 100047.png Supplementary Document Uploaded 2022-07-15 Repair queued
inquiry form page 2 part 2 Screenshot 2022-07-15 095841.png Supplementary Document Uploaded 2022-07-15 Repair queued
inquiry form page 2 Screenshot 2022-07-15 095245.png Supplementary Document Uploaded 2022-07-15 Repair queued
ask-ebsa-form-mock-up.png Supplementary Document Uploaded 2022-07-13 Repair queued
30-day FRN (1210-0146) published.pdf Supplementary Document Uploaded 2021-01-14 Repair queued
29 U.S. Code § 1134 - Investigative authority.pdf Supplementary Document Uploaded 2021-01-07 Repair queued
29 U.S. Code § 1143 - Research, studies, and reports _ U.S. Code _ US Law _ LII _ Legal Information Institute.pdf Supplementary Document Uploaded 2021-01-07 Repair queued
60-day FRN (1210-0146) published.pdf Supplementary Document Uploaded 2021-01-07 Repair queued
Supporting Statement Web Intake Form 2020 (clean) 1.7.21.docx Supporting Statement A Uploaded 2021-01-07 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
198333 Customer Service Intake Form Form and Instruction Unchanged
ICR Details
1210-0146 202207-1210-002
Received in OIRA 202011-1210-003
DOL/EBSA
Request for Assistance from the Department of Labor, Employee Benefits Security Administration
No material or nonsubstantive change to a currently approved collection   No
Regular 07/18/2022
  Requested Previously Approved
03/31/2024 03/31/2024
5,582 5,582
2,791 2,791
0 0
EBSA assists participants in understanding their rights, responsibilities, and benefits under employee benefit law and intervenes informally on their behalf with the plan sponsor in order to assist them in obtaining the health and retirement benefits to which they may have been inappropriately denied, which can avert the necessity for a formal investigation or a civil action. EBSA has made a request for assistance form available on its Web site for those wishing to obtain assistance in this manner.
US Code: 29 USC 1143 Name of Law: ERISA Section 513
   US Code: 29 USC 1134 Name of Law: ERISA Section 504
  
None
Not associated with rulemaking
  85 FR 66580 10/20/2020
86 FR 3204 01/14/2021
No
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,582 5,582 0 0 0 0
Annual Time Burden (Hours) 2,791 2,791 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The hour burden and monetized equivalent cost has been adjusted to reflect updated information on the number of web requests and labor costs.
$1,500
No
    No
    No
No
No
No
No
James Butikofer 202 693-8434 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/18/2022