Information Collection

Termination of Multiemployer Plans (29 CFR Part 4041A)

IC 13529 under ICR 202504-1212-007 · OMB 1212-0020.

Documents and Forms

Document Name Document Type
Form 001 Termination of Multiemployer Plans (29 CFR Part 4041A) Form and Instruction
Form 001 Notice of Termination Termination of Multiemployer Plans (29 CFR Part 4041A) Form and Instruction
Form 002 Actuarial Valuation Termination of Multiemployer Plans (29 CFR Part 4041A) Form and Instruction
final-terminated-insolvent-reg-instructions 5-8-25.pdf efiling.pbgc.gov/ Instruction
final-terminated-insolvent-reg-instructions 5-8-25.pdf efiling.pbgc.gov/ Instruction
001 Notice of Termination Final.NOT_05082019.pdf efilingportal.pbgc.gov/site/ Form and Instruction
001 Notice of Termination Final.NOT_05082019.pdf efilingportal.pbgc.gov/site/ Form and Instruction
002 Actuarial Valuation Final.Actuarial_05082019.pdf efilingportal.pbgc.gov/site/ Form and Instruction
002 Actuarial Valuation Final.Actuarial_05082019.pdf efilingportal.pbgc.gov/site/ Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Termination of Multiemployer Plans (29 CFR Part 4041A)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4041A (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	001	Notice of Termination	Final.NOT_05082019.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form and Instruction	002	Actuarial Valuation	Final.Actuarial_05082019.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Instruction			final-terminated-insolvent-reg-instructions 5-8-25.pdf	https://efiling.pbgc.gov/	Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 117	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	729	-88	817
Annual IC Time Burden (Hours)	32	-29	61
Annual IC Cost Burden (Dollars)	27,600	-11,800	39,400

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.

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