Information Collection

Notice, Collection, and Redetermination of Withdrawal Liability (29 CFR Part 4219)

IC 13558 under ICR 202303-1212-005 · OMB 1212-0034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0034 can be found here:

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Information Collection (IC) Details

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IC Title:	Notice, Collection, and Redetermination of Withdrawal Liability (29 CFR Part 4219)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4219

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3	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	3	-803	806
Annual IC Time Burden (Hours)	15	-30	45
Annual IC Cost Burden (Dollars)	49,500	-99,000	148,500

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.