Information Collection

Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)

IC 13583 under ICR 201911-1212-003 · OMB 1212-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0049 can be found here:

Documents and Forms

Document Name Document Type
Form Appendix 1 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Form
4010 e-Filing Portal screenshots to OMB.pdf www.pbgc.gov Other-screenshots
Final Appendix 2 - 4010 illustrative instructions to OMB.d2.pdf www.pbgc.gov Instruction
Appendix 1 Appendix 1 - 4010 Illustrative form Final Appendix 1 - 4010 illustrative form to OMB.pdf www.pbgc.gov Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4010

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Appendix 1	Appendix 1 - 4010 Illustrative form	Final Appendix 1 - 4010 illustrative form to OMB.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Other-screenshots			4010 e-Filing Portal screenshots to OMB.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Instruction			Final Appendix 2 - 4010 illustrative instructions to OMB.d2.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 560	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	560	0	560
Annual IC Time Burden (Hours)	515	-17	532
Annual IC Cost Burden (Dollars)	12,863,858	-7,182	12,871,040

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.