Information Collection

Notice of Insolvency (29 CFR Part 4245)

IC 13555 under ICR 201811-1212-003 · OMB 1212-0033.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0033 can be found here:

Documents and Forms

Document Name Document Type
Form 001 Notice of Insolvency (29 CFR Part 4245) Form
001 Notice of Insolvency Benefit Level NOIBL.pdf efilingportal.pbgc.gov/site/ Form
002 Notice of Insolvency NOI.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:	Notice of Insolvency (29 CFR Part 4245)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4245

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	001	Notice of Insolvency Benefit Level	NOIBL.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form	002	Notice of Insolvency	NOI.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: 1	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,598	0	2,598
Annual IC Time Burden (Hours)	20	19	1
Annual IC Cost Burden (Dollars)	12,000	11,277	723

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.