Administrative Appeals (Individuals)

Administrative Appeals

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0061 can be found here:

Documents and Forms

Document Name Document Type
Form PBGC Form 724 Administrative Appeals (Individuals) Form
PBGC Form 723 Request for Additional Time to File an Appeal of a PBGC e723 (2).doc Form
PBGC Form 724 Appeal of a PBGC Benefit Determination e724 (2).doc Form

Information Collection (IC) Details

IC Title:	Administrative Appeals (Individuals)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 4003 Subpart D

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PBGC Form 724	Appeal of a PBGC Benefit Determination	e724 (2).doc		No		Paper Only
Form	PBGC Form 723	Request for Additional Time to File an Appeal of a PBGC Benefit Determination	e723 (2).doc		No		Paper Only

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 846	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	846	846
Annual IC Time Burden (Hours)	590	590
Annual IC Cost Burden (Dollars)	43,298	43,298

Documents for IC

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.