Information Collection

Administrative Appeals (Individuals)

IC 46311 under ICR 201905-1212-010 · OMB 1212-0061.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0061 can be found here:

Documents and Forms

Document Name Document Type
Form 723 Administrative Appeals (Individuals) Form and Instruction
724 Appeal of a PBGC Benefit Determination Form e724 v. 2.pdf www.pbgc.gov/documents/e724.pdf Form and Instruction
723 Request for Additional Time to File an Appeal to a PBGC Form e723 v. 2.pdf www.pbgc.gov/documents/e723.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Administrative Appeals (Individuals)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 4003 Subpart D

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	723	Request for Additional Time to File an Appeal to a PBGC Benefit Determination	Form e723 v. 2.pdf	http://www.pbgc.gov/documents/e723.pdf	Yes	No	Printable Only
Form and Instruction	724	Appeal of a PBGC Benefit Determination	Form e724 v. 2.pdf	http://www.pbgc.gov/documents/e724.pdf	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 597	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	597	-299	896
Annual IC Time Burden (Hours)	211	-432	643
Annual IC Cost Burden (Dollars)	33,273	-10,507	43,780

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.