Administrative Appeals

Forms and Documents

Document Name	Status
Form PBGC Form 724 Administrative Appeals (Individuals) Form	New
supportingstatement.rocis.doc Supporting Statement A	2006-12-07

IC Document Collections

IC ID	Document Title	Status
46312	Administrative Appeals (Employers)	New
46311	Administrative Appeals (Individuals) Form	New

ICR Details

OMB Control No: 1212-0061	ICR Reference No: 200612-1212-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: PBGC	Agency Tracking No:
Title: Administrative Appeals
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/31/2007
	Date Received in OIRA: 12/07/2006
Terms of Clearance: OMB approves this bootleg collection. PBGC will make every effort to ensure that all information collections subject to the Paperwork Reduction Act (PRA) are submitted to OMB in a timely manner, prior to the collection of data from respondents.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved
Responses	850	0	0
Time Burden (Hours)	590	0	0
Cost Burden (Dollars)	46,004	0	0

---

Abstract: The PBGC’s regulation on Rules for Administrative Review of Agency Decisions prescribes rules governing the issuance of initial determinations by the PBGC and the procedures for requesting and obtaining administrative review of initial determinations. For those types of initial determinations subject to administrative appeals, the regulation prescribes rules on who may file appeals, when and where to file appeals, contents of appeals, and other matters relating to appeals. Most appeals filed with the PBGC are filed by individuals (participants, beneficiaries, and alternate payees) in connection with benefit entitlement or amounts. A small number of appeals are filed by employers in connection with other matters, such as plan coverage or employer liability. Appeals may be filed by hand, mail, commercial delivery service, fax or e-mail. For appeals of benefit determinations, the PBGC has developed new optional forms for filing appeals and requests for extensions of time to appeal.

---

Authorizing Statute(s): US Code: 29 USC 1303 Name of Law: ERISA
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 51650	08/30/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 70797	12/06/2006
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Administrative Appeals (Employers)
Administrative Appeals (Individuals)	PBGC Form 724, PBGC Form 723	Appeal of a PBGC Benefit Determination ,   Request for Additional Time to File an Appeal of a PBGC Benefit Determination

---

ICR Summary 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	850	0	0	0	0	850
Annual Time Burden (Hours)	590	0	0	0	0	590
Annual Cost Burden (Dollars)	46,004	0	0	0	0	46,004

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:

---

Annual Cost to Federal Government: $42,500

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

---

Common Form ICR:  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:

(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: 12/07/2006

---