OMB control number

Special Financial Assistance by PBGC

OMB 1212-0074 · PBGC.

OMB 1212-0074

Under section 4262 of the Employee Retirement Income Security Act of 1974 (ERISA) PBGC administers a Special Financial Assistance program for financially troubled multiemployer plans. The statute sets forth the requirements for this program, including specifying which plans are eligible to apply, the cutoff date for applications, actuarial assumptions, determinations on applications, restrictions and conditions on plans that receive SFA, and the requirements for certain plans with suspended benefits to reinstate those benefits and provide make-up payments to restore previously suspended benefits. Unlike financial assistance under section 4261 of ERISA, which is provided in the form of a loan and in periodic payments, a plan receiving SFA under section 4262 has no obligation to repay SFA. This information collection contains the requirements necessary to implement the SFA program and to provide proper stewardship of taxpayer funds. These information requirements include: • An application for SFA (including calculating the amount of SFA) that the plan sponsor of an eligible multiemployer plan must file with PBGC to receive payment of SFA. PBGC needs the information in the application to review a plan’s eligibility for SFA, priority group status (if applicable), and amount of requested SFA. • A lock-in application that plan may, but is not required, to use to lock in its base data. PBGC needs the information in the lock-in application to garner a plan's base data when the plan files a full application for SFA> • An Annual Statement of Compliance (with the restrictions and conditions under section 4262 of ERISA and 29 CFR part 4262) that a plan that has received SFA is required to file with PBGC. PBGC needs the information in the Annual Statement of Compliance to ensure that a plan is compliant with the imposed restrictions and conditions. • A notice of reinstatement that a plan sponsor of a plan with benefits that were suspended under sections 305(e)(9) or 4245(a) of ERISA must issue to participants and beneficiaries whose benefits are reinstated. Participants and beneficiaries need the notice of reinstatement to better understand the calculation and timing of their reinstated benefits and, if applicable, make-up payments. • A request for a determination from PBGC for approval for an exception under certain circumstances for SFA conditions under § 4262.16 relating to reductions in contributions, transfers or mergers, benefit increases, and settlement of withdrawal liability. PBGC needs the information required for a request for determination to determine whether to approve an exception from the specified condition.

The latest form for Special Financial Assistance by PBGC expires 2027-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material
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All Historical Document Collections
No material or nonsubstantive change to a currently approved collection 2026-05-08
Approved without change
No material or nonsubstantive change to a currently approved collection 2025-03-19
Approved without change
No material or nonsubstantive change to a currently approved collection 2024-07-03
Approved without change
Revision of a currently approved collection 2024-03-28
Approved without change
Revision of a currently approved collection 2023-11-01
Approved with change
No material or nonsubstantive change to a currently approved collection 2023-09-25
Approved with change
Revision of a currently approved collection 2023-06-02
Approved without change
No material or nonsubstantive change to a currently approved collection 2023-03-07
Approved without change
Revision of a currently approved collection 2023-01-26
Approved without change
Revision of a currently approved collection 2022-11-29
Approved without change
No material or nonsubstantive change to a currently approved collection 2022-10-24
Approved without change
No material or nonsubstantive change to a currently approved collection 2022-08-10
Approved without change
No material or nonsubstantive change to a currently approved collection 2022-08-03
Approved without change
Revision of a currently approved collection 2022-07-08
Approved with change
Extension without change of a currently approved collection 2021-12-08
Approved without change
No material or nonsubstantive change to a currently approved collection 2021-12-03
Approved without change
New collection (Request for a new OMB Control Number) 2021-07-09
OMB Details

Application for Special Financial Assistance

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SFA 201SFA Template 1www.pbgc.gov/sites/default/files/sfa/template-1.xlsxForm and instruction
Form SFA 100SFA Application Checklistwww.pbgc.gov/arp-sfa/more-resourcesForm and instruction
Form PBGC E-filing PortalPBGC E-filing PortalFillable FileableForm
Form SFA Template 10SFA Template 10www.pbgc.gov/documents/pre-2021-zone-certification-baseline-details-and-final-sfa-assumption-summariesForm and instruction
Form Model Plan Amendment, ReinstatementModel Plan Amendment, Reinstatementwww.pbgc.gov/sites/default/files/documents/model-plan-amendment-reinstatement.docxForm and instruction
Form SFA 100-SupplementedSFA Template Checklist, Supplemented Applicationwww.pbgc.gov/sites/default/files/sfa/checklist-supplemented-sfa-application.xlsxForm and instruction
Form www.pbgc.gov/sites/default/files/sfa/sfa-filing-instructions.pdfInstruction
Form Model CertificationModel Certificationwww.pbgc.gov/sites/default/files/documents/model-certification-plan-sponsor-reinstatement.docxForm and instruction
Form SFA Application Amendment Cover LetterSFA Application Amendment Cover Letterwww.pbgc.gov/documents/sfa-application-amendment-cover-letterForm and instruction
Form SFA Filing Instructions, Addendum DSFA Filing Instructions, Addendum DFillable FileableForm and instruction
Form SFA Filing Instructions, Addendum CSFA Filing Instructions, Addendum CFillable FileableForm and instruction
Form Model Plan Amendment ComplianceModel Plan Amendment Compliancewww.pbgc.gov/sites/default/files/documents/model-plan-amendment-compliance.docxForm and instruction
Form SFA Filing Instructions, Addendum ASFA Filing Instructions, Addendum AFillable FileableForm and instruction
Form SFA 206-ASFA Template 6Awww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6a.xlsxForm and instruction
Form SFA 207SFA Template 7www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-7.xlsxForm and instruction
Form SFA 208SFA Template 8www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-8.xlsxForm and instruction
Form SFA 209SFA Template 9www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-9.xlsxForm and instruction
Form SFA 205-BSFA Template 5Bwww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5b.xlsxForm and instruction
Form SFA 205-ASFA Template 5Awww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5a.xlsxForm and instruction
Form SFA 206-BSFA Template 6Bwww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6b.xlsxForm and instruction
Form SFA 204-BSFA Template 4Bwww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4b.xlsxForm and instruction
Form SFA 204-ASFA Template 4Awww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4a.xlsxForm and instruction
Form SFA 203SFA Template 3www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-3.xlsxForm and instruction
Form SFA 202SFA Template 2www.pbgc.gov/sites/default/files/sfa/template-2.xlsxForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.