Information Collection

Reportable Events

IC 13522 under ICR 201202-1212-002 · OMB 1212-0013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0013 can be found here:

Documents and Forms

Document Name Document Type
Form 10 Reportable Events Form
Form 10 Instr._2012 ROLLOVER_to OMB.pdf Instruction
Form 10 ADV Instr._2012 ROLLOVER_to OMB.pdf Instruction
10 Post-Event Notice of Reportable Events Form 10_2012 ROLLOVER_to OMB.pdf www.pbgc.gov/documents/10.pdf Form
10-Advance Advance Notice of Reportable Events Form 10 ADV_2012 ROLLOVER_to OMB.pdf www.pbgc.gov/Documents/10_A.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Reportable Events	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10	Post-Event Notice of Reportable Events	Form 10_2012 ROLLOVER_to OMB.pdf	http://www.pbgc.gov/documents/10.pdf	Yes	Yes	Fillable Fileable
Instruction			Form 10 Instr._2012 ROLLOVER_to OMB.pdf		Yes	Yes	Printable Only
Form	10-Advance	Advance Notice of Reportable Events	Form 10 ADV_2012 ROLLOVER_to OMB.pdf	http://www.pbgc.gov/Documents/10_A.pdf	Yes	Yes	Fillable Fileable
Instruction			Form 10 ADV Instr._2012 ROLLOVER_to OMB.pdf		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: 1,026	Number of Respondents for Small Entity: 286

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 55 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,026	389	637
Annual IC Time Burden (Hours)	3,078	402	2,676
Annual IC Cost Burden (Dollars)	821,826	-114,774	936,600

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.