Information Collection

Qualified Domestic Relations Orders submitted to PBGC

IC 43802 under ICR 202502-1212-002 · OMB 1212-0054.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0054 can be found here:

Documents and Forms

Document Name Document Type
QDRO 2025 Spanish v 20250226 v.02 clean.docx Instruction
QDRO 2025 Spanish v 20250226 v.02 clean.docx Instruction
QDRO 2025 English v 20250226 v.02 clean.docx Instruction
QDRO 2025 English v 20250226 v.02 clean.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Qualified Domestic Relations Orders submitted to PBGC	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			QDRO 2025 Spanish v 20250226 v.02 clean.docx		Yes	Yes	Paper Only
Instruction			QDRO 2025 English v 20250226 v.02 clean.docx		Yes	Yes	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 253	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	253	253
Annual IC Time Burden (Hours)	190	190
Annual IC Cost Burden (Dollars)	177,100	177,100

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.