OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Application for Special Financial Assistance

IC 247975 under ICR 202402-1212-002 · OMB 1212-0074.

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Information Collection (IC) Details

View Information Collection (IC)

Application for Special Financial Assistance
 
No Modified
 
Required to Obtain or Retain Benefits
 
29 CFR 4262

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SFA 201 SFA Template 1 Template 1 v20220701p (5).xlsx https://www.pbgc.gov/sites/default/files/sfa/template-1.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 202 SFA Template 2 part-4262-final-rule-template-2 .xlsx https://www.pbgc.gov/sites/default/files/sfa/template-2.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 203 SFA Template 3 Template 3.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-3.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 204-A SFA Template 4A part-4262-final-rule-template-4a.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4a.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 204-B SFA Template 4B part-4262-final-rule-template-4b .xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4b.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 205-A SFA Template 5A part-4262-final-rule-template-5a .xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5a.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 205-B SFA Template 5B part-4262-final-rule-template-5b.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5b.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 206-B SFA Template 6B part-4262-final-rule-template-6b .xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6b.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 207 SFA Template 7 part-4262-final-rule-template-7 .xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-7.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 208 SFA Template 8 part-4262-final-rule-template-8 .xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-8.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 206-A SFA Template 6A part-4262-final-rule-template-6a.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6a.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 209 SFA Template 9 part-4262-final-rule-template-9 .xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-9.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA Filing Instructions, Addendum A SFA Filing Instructions, Addendum A addendum-a-engaged-certain-events.pdf Yes Yes Fillable Fileable
Form and Instruction SFA Filing Instructions, Addendum C SFA Filing Instructions, Addendum C addendum-c-ifr-filers-supplemental-application.pdf Yes Yes Fillable Fileable
Form and Instruction SFA Filing Instructions, Addendum D SFA Filing Instructions, Addendum D addendum-d-mpra-plans.pdf Yes Yes Fillable Fileable
Form and Instruction SFA 100 SFA Application Checklist checklist-general-sfa-application .xlsx https://www.pbgc.gov/sites/default/files/sfa/checklist-general-sfa-application.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 100-Supplemented SFA Template Checklist, Supplemented Application checklist-supplemented-sfa-application .xlsx https://www.pbgc.gov/sites/default/files/sfa/checklist-supplemented-sfa-application.xlsx Yes Yes Fillable Fileable
Form PBGC E-filing Portal PBGC E-filing Portal SFA EFP Screenshots.docx Yes Yes Fillable Fileable
Form and Instruction SFA Application Amendment Cover Letter SFA Application Amendment Cover Letter sfa-application-amendment-cover-letter.pdf https://www.pbgc.gov/documents/sfa-application-amendment-cover-letter Yes Yes Fillable Fileable
Form and Instruction Model Plan Amendment Compliance Model Plan Amendment Compliance model-plan-amendment-compliance.docx https://www.pbgc.gov/sites/default/files/documents/model-plan-amendment-compliance.docx Yes Yes Fillable Fileable
Form and Instruction Model Plan Amendment, Reinstatement Model Plan Amendment, Reinstatement model-plan-amendment-reinstatement.docx https://www.pbgc.gov/sites/default/files/documents/model-plan-amendment-reinstatement.docx Yes Yes Fillable Fileable
Form and Instruction Model Certification Model Certification model-certification-plan-sponsor-reinstatement.docx https://www.pbgc.gov/sites/default/files/documents/model-certification-plan-sponsor-reinstatement.docx Yes Yes Fillable Fileable
Instruction sfa-filing-instructions.pdf https://www.pbgc.gov/sites/default/files/sfa/sfa-filing-instructions.pdf Yes Yes Fillable Fileable
Form and Instruction SFA Template 10 SFA Template 10 Copy of pre-2021-final-sfa-assumption-summaries-template-10.xlsx https://www.pbgc.gov/documents/pre-2021-zone-certification-baseline-details-and-final-sfa-assumption-summaries Yes Yes Fillable Fileable

Income Security General Retirement and Disability

PBGC – 19: Office of General Counsel Case Management System  83 FR 6247

45 0
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 45 0 -14 0 0 59
Annual IC Time Burden (Hours) 540 0 -168 0 0 708
Annual IC Cost Burden (Dollars) 1,530,000 0 -476,000 0 0 2,006,000

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