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Federal forms, ICRs, and supporting documents

Information Collection Request

Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)

ICR 202602-1212-002 · OMB 1212-0049 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form Appendix 1 Appendix 1 - 4010 Illustrative form Form Modified Repair queued
Justification of nonmaterial change_1212-0049 4010 filing.03.docx Justification for No Material/Nonsubstantive Change Uploaded 2026-02-25 Repair queued
4010 ICR Supporting Statement 2025.04.docx Supporting Statement A Uploaded 2025-08-20 Repair queued
Justification Nonmaterial Change 4010 instructions.v2.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-01-16 Available
Justification Nonmaterial Change 4010 instructions.v6.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-07-08 Repair queued
Justification Nonmaterial Change 4010 instructions.v1.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-01-18 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
13583 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Form ModifiedAppendix 1 - 4010 Illustrative form
13583 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Other-screenshots Modified
ICR Details
1212-0049 202602-1212-002
Active 202508-1212-001
PBGC
Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 03/03/2026
Retrieve Notice of Action (NOA) 02/27/2026
  Inventory as of this Action Requested Previously Approved
09/30/2028 09/30/2028 09/30/2028
300 0 300
600 0 600
9,180,000 0 9,180,000
ERISA section 4010 requires the annual reporting of actuarial and financial information by controlled groups that sponsor pension plans that have significant underfunding. PBGC uses this information to detect and monitor financial problems with the controlled groups and to respond quickly when it learns that a controlled group intends to engage in a transaction that may reduce the assets available to pay plan liabilities.
US Code: 29 USC 1310 Name of Law: ERISA
  
None
1212-AB51 Final or interim final rulemaking 90 FR 39320 08/15/2025
No
1
IC Title Form No. Form Name
Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Appendix 1 Appendix 1 - 4010 Illustrative form
  Total Approved 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 300 300 0 0 0 0
Annual Time Burden (Hours) 600 600 0 0 0 0
Annual Cost Burden (Dollars) 9,180,000 9,180,000 0 0 0 0
No
No
$12,000
No
    No
    No
No
No
No
No
Monica O'Donnell 202 229-8706 o'[email protected]
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
02/27/2026