OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Request for Coverage Determination

OMB 1212-0072 · PBGC.

OMB 1212-0072

This form is used by a plan administrator or plan sponsor of a plan to request that the Pension Benefit Guaranty Corporation determine whether a plan is covered under title IV of the Employee Retirement Income Security Act of 1974.

The latest form for Request for Coverage Determination expires 2028-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form
Form
Justification for No Material/Nonsubstantive Change
Justification for No Material/Nonsubstantive Change
Supporting Statement A
Supporting Statement A
All Historical Document Collections
Approved without change
 No material or nonsubstantive change to a currently approved collection 2025-11-21
Revision of a currently approved collection 2025-05-19
Approved without change
 Revision of a currently approved collection 2022-05-09
Approved with change
 New collection (Request for a new OMB Control Number) 2019-05-08