Information Collection

Notice of Insolvency (29 CFR Part 4245)

IC 13555 under ICR 201905-1212-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Final.Terminated Insolvent Reg Instructions.5-7-19.pdf efilingportal.pbgc.gov/site/ Instruction
001 Notice of Insolvency Benefit Level Final.NOIBL_05082019.pdf efilingportal.pbgc.gov/site/ Form
002 Notice of Insolvency Final.NOI_05082019.pdf efilingportal.pbgc.gov/site/ Form
003 Combined Notice of Insolvency and Notice of Insolvency B Final.Combined NOI and NOIBL 05082019.pdf efilingportal.pbgc.gov/site/ Form and Instruction

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	Final.NOIBL_05082019.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form	002	Notice of Insolvency	Final.NOI_05082019.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Instruction			Final.Terminated Insolvent Reg Instructions.5-7-19.pdf	https://efilingportal.pbgc.gov/site/	Yes	No	Printable Only
Form and Instruction	003	Combined Notice of Insolvency and Notice of Insolvency Benefit Level	Final.Combined NOI and NOIBL 05082019.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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,038	-1,560	2,598
Annual IC Time Burden (Hours)	16	-4	20
Annual IC Cost Burden (Dollars)	10,000	-2,000	12,000

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.