Locating and Paying Participants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 722 Financial Statement of Debtor	Form and Instruction	Modified	Available
Form 718 Installment Repayment Agreement	Form and Instruction	Modified	Available
Form 717 Monthly Payment Election Form	Form and Instruction	Modified	Available
Form 702 General Information Form	Form and Instruction	Modified	Available
Form 721 Estate or Non-Spouse Beneficiary Application for Taxable Single Payment	Form and Instruction	Modified	Available
Form 720 Application for Lump Sum Payment	Form and Instruction	Modified	Available
Form 719 Election to Withhold Federal Income Tax from Periodic Payments	Form and Instruction	Modified	Available
Form 715 Power of Attorney	Form and Instruction	Modified	Available
Form 714 Surviving Spouse Election for Return of Participant Contributions	Form and Instruction	Modified	Available
Form 713 Return of Employee Contributions, Participant	Form and Instruction	Modified	Available
Form 710 Application for Electronic Direct Deposit	Form and Instruction	Modified	Available
Form 709 Plan Participant Information	Form and Instruction	Modified	Available
Form 708 Designation of Beneficiary (Not currently receiving benefits)	Form and Instruction	Modified	Available
Form 707 Designation of Beneficiary	Form and Instruction	Modified	Available
Form 706 Beneficiary Application for Pension Benefits -- OF	Form and Instruction	Modified	Available
Form 705 Beneficiary Application for Pension Benefits	Form and Instruction	Modified	Available
Form 701 Payee Information Form	Form and Instruction	Modified	Available
Form 700 Application for Benefits	Form and Instruction	Modified	Available
Form 703 Application for Elective Lump Sum	Form and Instruction	Modified	Available
Justification MYPBA screens Final.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2006-11-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Financial Statement of Debtor
13603	Locating and Paying Participants	Form and Instruction	Modified	Installment Repayment Agreement
13603	Locating and Paying Participants	Form and Instruction	Modified	Monthly Payment Election Form
13603	Locating and Paying Participants	Form and Instruction	Modified	General Information Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Estate or Non-Spouse Beneficiary Application for Taxable Single Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lump Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Election to Withhold Federal Income Tax from Periodic Payments
13603	Locating and Paying Participants	Form and Instruction	Modified	Power of Attorney
13603	Locating and Paying Participants	Form and Instruction	Modified	Surviving Spouse Election for Return of Participant Contributions
13603	Locating and Paying Participants	Form and Instruction	Modified	Return of Employee Contributions, Participant
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Electronic Direct Deposit
13603	Locating and Paying Participants	Form and Instruction	Modified	Plan Participant Information
13603	Locating and Paying Participants	Form and Instruction	Modified	Designation of Beneficiary (Not currently receiving benefits)
13603	Locating and Paying Participants	Form and Instruction	Modified	Designation of Beneficiary
13603	Locating and Paying Participants	Form and Instruction	Modified	Beneficiary Application for Pension Benefits -- OF
13603	Locating and Paying Participants	Form and Instruction	Modified	Beneficiary Application for Pension Benefits
13603	Locating and Paying Participants	Form and Instruction	Modified	Payee Information Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Benefits
13603	Locating and Paying Participants	Other-Screen print	Modified
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Elective Lump Sum

ICR Details

OMB Control No: 1212-0055	ICR Reference No: 200611-1212-009
Status: Historical Active	Previous ICR Reference No: 200507-1212-001
Agency/Subagency: PBGC	Agency Tracking No:
Title: Locating and Paying Participants
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/06/2006
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/04/2006
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2008	08/31/2008	08/31/2008
Responses	225,600	0	225,600
Time Burden (Hours)	118,475	0	118,475
Cost Burden (Dollars)	78,000	0	78,000

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Abstract: This collection consists of information participants and beneficiaries are asked to provide in connection with an application for benefits or request for a benefit estimate. In addition, in some instances, as part of a search for participants and beneficiaries who may be entitled to benefits, the PBGC requests individuals to provide identifying information that the individual would provide as part of an initial contact with the PBGC.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Locating and Paying Participants	705, 703, 701, 715, 719, 721, 720, 722, 702, 717, 710, 718, 706, 700, 708, 709, 707, 713, 714	Application for Benefits ,   Payee Information Form ,   Application for Elective Lump Sum ,   Beneficiary Application for Pension Benefits ,   Beneficiary Application for Pension Benefits -- OF ,   Designation of Beneficiary ,   Designation of Beneficiary (Not currently receiving benefits) ,   Plan Participant Information ,   Application for Electronic Direct Deposit ,   Return of Employee Contributions, Participant ,   Surviving Spouse Election for Return of Participant Contributions ,   Power of Attorney ,   Election to Withhold Federal Income Tax from Periodic Payments ,   Application for Lump Sum Payment ,   Estate or Non-Spouse Beneficiary Application for Taxable Single Payment ,   General Information Form ,   Monthly Payment Election Form ,   Installment Repayment Agreement ,   Financial Statement of Debtor

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ICR Summary of Burden

table that charts list of burden

	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	225,600	225,600	0	0	0	0
Annual Time Burden (Hours)	118,475	118,475	0	0	0	0
Annual Cost Burden (Dollars)	78,000	78,000	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/04/2006

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