Annual Information Return/Report of Employee Benefit Plan

OMB Control No: 1210-0110	ICR Reference No: 202102-1210-002
Status: Received in OIRA	Previous ICR Reference No: 202101-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Annual Information Return/Report of Employee Benefit Plan
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/25/2021

	Requested	Previously Approved
Expiration Date	11/30/2021	11/30/2021
Responses	822,000	814,000
Time Burden (Hours)	584,000	582,000
Cost Burden (Dollars)	280,637,000	278,555,000

---

Abstract: Section 104 and 4065 of ERISA require plan administrators to file an annual report containing the information described in section 103 of ERISA. The Form 5500 provides a standard format for fulfilling that requirement.

---

Authorizing Statute(s): US Code: 29 USC 1023 Name of Law: Employee Retirement Income Security Act of 1974

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 15635	04/11/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 46191	08/31/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title Form No. Form Name Annual Information Return/Report of Employee Benefit Plan Form 5500 Schedule G, Form 5500 Schedule H, Form 5500 Schedule D, Form 5500-SF, Form 5500 Schedule R, Form 5500, Form 5500 Schedule A, Form 5500 Schedule C, Form 5500 Schedule I, Form 5500 Schedule MB, Form 5500 Schedule SB Annual Return/Report of Employee Benefit Plan ,   Short Form Annual Return/Report of Small Employee Benefit Plan ,   Insurance Information ,   Service Provider Information ,   DFE/Participating Plan Information ,   Financial Transaction Schedules ,   Financial Information ,   Financial Information--Small Plans ,   Multiemployer Defined Benefit Plans and Certain Money Purchase Plan Actuarial Information ,   Single-Employer Defined Benefit Plan Actuarial Information ,   Retirement Plan Information

---

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	822,000	814,000	0	0	8,000	0
Annual Time Burden (Hours)	584,000	582,000	0	0	2,000	0
Annual Cost Burden (Dollars)	280,637,000	278,555,000	0	0	2,082,000	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden has increased due to updated agency estimates of the number of plans and labor rates.

---

Annual Cost to Federal Government: $6,100,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: James Butikofer 202 693-8434 [email protected]

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
		(a) It is necessary for the proper performance of agency functions;
		(b) It avoids unnecessary duplication;
		(c) It reduces burden on small entities;
		(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
		(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
		(f) It indicates the retention periods for recordkeeping requirements;
		(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
			(i) Why the information is being collected;
			(ii) Use of information;
			(iii) Burden estimate;
			(iv) Nature of response (voluntary, required for a benefit, or mandatory);
			(v) Nature and extent of confidentiality; and
			(vi) Need to display currently valid OMB control number;
		(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
		(i) It uses effective and efficient statistical survey methodology (if applicable); and
		(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date: 03/25/2021

---