Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Notice of Availability of Separate Payments for Contraceptive Services Modified 595307 68 149303 Other-Model
Notice of Revocation of Accommodation Modified 182051 109 45658
Self-Certification or Notification Modified 5 4 2 Other-Model Notice
Form EBSA Form 700 Eligible Organization Self-Certification
Total burden requested under this ICR: 777363 181 194963  
To view an IC, click on IC Title