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 181218 Other-Model
Notice of Revocation of Accommodation Removed 0 0 0
Self-Certification or Notification Modified 5 4 4 Other-Model Notice
Form EBSA Form 700
Total burden requested under this ICR: 595312 72 181222  
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