Information Collection

Notice of Failure to Make Required Contributions

IC 13574 under ICR 201202-1212-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Instr._2012 ROLLOVER_to OMB.pdf Instruction
200 Notice of Failure to Make Required Contributions Form 200_2012 ROLLOVER_to OMB.pdf www.pbgc.gov/Documents/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
Instruction			Form 200 Instr._2012 ROLLOVER_to OMB.pdf		Yes	Yes	Printable Only
Form	200	Notice of Failure to Make Required Contributions	Form 200_2012 ROLLOVER_to OMB.pdf	http://www.pbgc.gov/Documents/200.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: 111	Number of Respondents for Small Entity: 8

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	111	-315	426
Annual IC Time Burden (Hours)	333	-540	873
Annual IC Cost Burden (Dollars)	102,146	-203,404	305,550

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.