Information Collection

Termination of Multiemployer Plans (29 CFR Part 4041A)

IC 13529 under ICR 201812-1212-001 · OMB 1212-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0020 can be found here:

Documents and Forms

Document Name Document Type
Form 001 Termination of Multiemployer Plans (29 CFR Part 4041A) Form
Ppsd.Terminated Insolvent Reg Instructions.7-11-18.pdf efilingportal.pbgc.gov/site/ Instruction
001 Notice of Termination Ppsd.Notice of Termination 7-11-18.pdf efilingportal.pbgc.gov/site/ Form
002 Withdrawal Liability Information Ppsd.Withdrawal Liability Information 7-11-18.pdf efilingportal.pbgc.gov/site/ Form
003 Actuarial Valuation Ppsd.Actuarial Valuation Information 7-11-18.pdf efilingportal.pbgc.gov/site/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Termination of Multiemployer Plans (29 CFR Part 4041A)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4041A (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	001	Notice of Termination	Ppsd.Notice of Termination 7-11-18.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form	002	Withdrawal Liability Information	Ppsd.Withdrawal Liability Information 7-11-18.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form	003	Actuarial Valuation	Ppsd.Actuarial Valuation Information 7-11-18.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Instruction			Ppsd.Terminated Insolvent Reg Instructions.7-11-18.pdf	https://efilingportal.pbgc.gov/site/	Yes	No	Paper Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,000	1,000	1,000
Annual IC Time Burden (Hours)	229	160	69
Annual IC Cost Burden (Dollars)	114,000	64,000	50,000

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.