Information Collection

Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)

IC 13552 under ICR 201809-1212-002 · OMB 1212-0032.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0032 can be found here:

Documents and Forms

Document Name Document Type
Form Form 1 Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281) Form
Form 1 Notice of Insolvency Benefit Level NOIBL.pdf efilingportal.pbgc.gov/site/ Form
Form 2 Notice of Insolvency NOI.pdf efilingportal.pbgc.gov/site/ Form
Form 3 Application for Financial Assistance - Initial Application for Initial FA.pdf efilingportal.pbgc.gov/site/ Form
Form 4 Application for Financial Assistance - Recurring Application for Recurring FA.pdf efilingportal.pbgc.gov/site/ Form
E-Filing Portal - Paperwork Reduction Act Notice 9-5.docx PRA Notice IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4281

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form 1	Notice of Insolvency Benefit Level	NOIBL.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form	Form 2	Notice of Insolvency	NOI.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form	Form 3	Application for Financial Assistance - Initial	Application for Initial FA.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form	Form 4	Application for Financial Assistance - Recurring	Application for Recurring FA.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	167,547	3,046	164,501
Annual IC Time Burden (Hours)	1,300	1,240	60
Annual IC Cost Burden (Dollars)	615,400	306,380	309,020

Documents for IC

Title	Document	Date Uploaded
PRA Notice	E-Filing Portal - Paperwork Reduction Act Notice 9-5.docx	09/11/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.