Information Collection

Disclosure of Termination Information

IC 182656 under ICR 200711-1212-001 · OMB 1212-0065.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0065 can be found here:

Documents and Forms

Document Name Document Type
Disclosure of Distress Termination Information - Final.doc Instruction
Disclosure of PBGC-initiated Termination Information - Final.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Disclosure of Termination Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1342 29 CFR 1341

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Disclosure of Distress Termination Information - Final.doc		Yes	Yes	Printable Only
Instruction			Disclosure of PBGC-initiated Termination Information - Final.doc		Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	30,000	30,000
Annual IC Cost Burden (Dollars)	255,000	255,000

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.