View Information Collection (IC)

View Information Collection (IC)

Notice to Employees of Coverage Options Under FLSA 18B (Private Sector)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Model Notice model-notice-for-employers-who-offer-a-health-plan-to-some-or-all-employees.pdf Yes No Fillable Printable

Health Consumer Health and Safety

 

7,760,000 5,980,300
   
Private Sector Businesses or other for-profits, Farms, Not-for-profit institutions
 
   56 %

  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 27,760,144 0 0 2,514,616 0 25,245,528
Annual IC Time Burden (Hours) 100,781 0 0 -622 0 101,403
Annual IC Cost Burden (Dollars) 4,535,150 0 0 458,755 0 4,076,395

Title Document Date Uploaded
Technical Release 2013-02 DOL TR 2013-02.pdf 11/06/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.