Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Additional Information Request to Plan Administrator New 9500 4750 0 Form and Instruction EBSA Form 301 Request for Additonal Information from Plan Administrator
Request to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction New 95000 95000 52000 Form and Instruction EBSA Form 300 Request to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction
Total burden requested under this ICR: 104500 99750 52000  
To view an IC, click on IC Title