This is a summary of the annual report of the CARLTON STRATEGIC STAFFING, EIN 76-0469794, Plan No. 501,
for period 01/06/2020 through 01/03/2021. The annual report has been filed with the Employee Benefits
Security Administration, U.S. Department of Labor, as required under the Employee Retirement Income
Security Act of 1974 (ERISA).
CARLTON STRATEGIC STAFFING has committed itself to pay certain self-funded Stop Loss claims incurred
under the terms of the plan.
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request. The
items listed below are included in that report:
Insurance information, including sales commissions paid by insurance carriers;
To obtain a copy of the full annual report, or any part thereof, write or call the office of CARLTON
STRATEGIC STAFFING at 24 GREENWAY PLAZA, SUITE 1209, HOUSTON, TX, 77046 or by telephone at 713-358-7213.
You also have the legally protected right to examine the annual report at the main office of the plan
(CARLTON STRATEGIC STAFFING at 24 GREENWAY PLAZA, SUITE 1209, HOUSTON, TX, 77046) and at the U.S.
Department of Labor in Washington, D.C., or to obtain a copy from the U.S. Department of Labor upon
payment of copying costs. Requests to the Department should be addressed to: Public Disclosure Room,
Room N1513, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution
Avenue, N.W., Washington, D.C. 20210.
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to
respond to a collection of information unless such collection displays a valid Office of Management and
Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a
collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB
control number, and the public is not required to respond to a collection of information unless it
displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other
provision of law, no person shall be subject to penalty for failing to comply with a collection of
information if the collection of information does not display a currently valid OMB control number. See
44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average less than one
minute per notice (approximately 3 hours and 11 minutes per plan).
Interested parties are encouraged to send comments regarding the burden estimate or sny other aspect of
this collection of information, including suggestions for reducing the burden, to the U.S. Department of
Labor, Office of the Chief Information Officer, Attention: Departmental Clearance Officer, 200
Constitution Avenue, N.W., Room N-1301, Washington, DC 20210 or email DOL_PRA_PUBLIC@dol.gov and
reference the OMB Control Number 1210-0040.
OMB Control Number 1210-0040 (expires 06/30/2022)