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View Information Collection (IC)

Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)
No Modified
29 CFR 825.212(a)

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

Workforce Management Labor Rights Management


50,866 35,244
State, Local, and Tribal Governments
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 50,866 0 0 6,116 0 44,750
Annual IC Time Burden (Hours) 4,239 0 0 510 0 3,729
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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