Information Collection

Disclosure to Participants

IC 13586 under ICR 200611-1212-005 · OMB 1212-0050.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2006 Model Participant Notice.doc www.pbgc.gov/practitioners/law-regulations-informal-guidance/content/tu15820.html	Other-Model Notice

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4011

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Model Notice			2006 Model Participant Notice.doc	http://www.pbgc.gov/practitioners/law-regulations-informal-guidance/content/tu15820.html	Yes	Yes	Fillable Printable

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 764

Number of Respondents for Small Entity: 455

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	764	-3,153	0	3,917
Annual IC Time Burden (Hours)	1,057	-6,737	-634	8,428
Annual IC Cost Burden (Dollars)	290,675	-462,730	174,405	579,000

Documents for IC

table that charts IC Documents
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.