Information Collection

Notice of Failure to Make Required Contributions

IC 13574 under ICR 200901-1212-005 · OMB 1212-0041.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0041 can be found here:

Documents and Forms

Document Name Document Type
Form 200 Notice of Failure to Make Required Contributions Form
Form 200 Instr._Markup for 2009 (3-yr rollover)_to OMB.pdf Instruction
200 Notice of Failure to Make Required Contributions Form 200.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice of Failure to Make Required Contributions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4043

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	200	Notice of Failure to Make Required Contributions	Form 200.pdf		Yes	Yes	Paper Only
Instruction			Form 200 Instr._Markup for 2009 (3-yr rollover)_to OMB.pdf		Yes	Yes	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 185	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	426	348	78
Annual IC Time Burden (Hours)	873	713	160
Annual IC Cost Burden (Dollars)	305,550	261,550	44,000

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.