Information Collection

Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)

IC 13583 under ICR 201504-1212-001 · OMB 1212-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0049 can be found here:

Documents and Forms

Document Name Document Type
4010_efiling_instructions_rev1_post-ppa.pdf Instruction
e-4010 e-4010 Screenshots 4010_efiling_screenshots_rev1.pdf Form
e-4010 e-4010 Form 4010_efiling_webform_rev1.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			4010_efiling_instructions_rev1_post-ppa.pdf	Yes	Yes	Fillable Printable
Form	e-4010	e-4010 Screenshots	4010_efiling_screenshots_rev1.pdf	Yes	Yes	Fillable Fileable Signable
Form	e-4010	e-4010 Form	4010_efiling_webform_rev1.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200	-100	300
Annual IC Time Burden (Hours)	1,748	-872	2,620
Annual IC Cost Burden (Dollars)	3,392,000	-1,696,000	5,088,000

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.