Information Collection

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

IC 13583 under ICR 201603-1212-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form e-410 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Form
Appendix 2 - e4010 instructions for info years beg on or after Jan 1 2017.docx Instruction
e-410 e-4010 Form Appendix 1 - e4010 illustrative form for info years beg on or after Jan 1 2017.docx 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: 29 CFR 4010

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	e-410	e-4010 Form	Appendix 1 - e4010 illustrative form for info years beg on or after Jan 1 2017.docx		Yes	Yes	Fillable Fileable Signable
Instruction			Appendix 2 - e4010 instructions for info years beg on or after Jan 1 2017.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 410	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	410	210	200
Annual IC Time Burden (Hours)	3,600	1,852	1,748
Annual IC Cost Burden (Dollars)	6,560,000	3,168,000	3,392,000

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.