Annual Information Return/Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 5500 Annual Information Return/Report	Form	Modified	Available
2007 5500 Instructions (81707).pdf	Supplementary Document	Uploaded 2007-08-21	Available
75500ssa.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500r.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500i.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500h.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500g.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500e.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500ez.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500d.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500c.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500b.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500.pdf	Supplementary Document	Uploaded 2007-07-16	Available
75500a.pdf	Supplementary Document	Uploaded 2007-07-16	Available
PBGC NOTE TO REVIEWER July 2007.pdf	Supplementary Document	Uploaded 2007-07-16	Available
Supplemental Notice 6-9633.pdf	Supplementary Document	Uploaded 2007-06-11	Available
July Notice of Prop Forms Revision 06-6330.pdf	Supplementary Document	Uploaded 2007-06-11	Available
Form_5500_SF_70424.pdf	Supplementary Document	Uploaded 2007-07-17	Available
Form_5500_and_Schedules.pdf	Supplementary Document	Uploaded 2007-07-17	Available
PBGC 2009F5500ss07.d6.pdf	Supporting Statement A	Uploaded 2007-07-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13607	Annual Information Return/Report	Form	Modified

ICR Details

OMB Control No: 1212-0057	ICR Reference No: 200705-1212-001
Status: Historical Active	Previous ICR Reference No: 200410-1212-002
Agency/Subagency: PBGC	Agency Tracking No:
Title: Annual Information Return/Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/24/2007
	Date Received in OIRA: 07/17/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2010	36 Months From Approved	12/31/2007
Responses	30,300	0	28,900
Time Burden (Hours)	1,800	0	2,373
Cost Burden (Dollars)	1,600,000	0	1,737,000

---

Abstract: Sections 104 and 4065 of ERISA require plan administrators to file an annual report. The report must contain the information described in section 103 of ERISA. The Form 5500 Series provides a standard format for fulfilling that requirement.

---

Authorizing Statute(s): US Code: 29 USC 1302(b)(3), 1365 Name of Law: ERISA
  

Citations for New Statutory Requirements: Statute at Large: 120 Stat. 780 Name of Statute: Pension Protection Act of 2006

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB06	Final or interim final rulemaking	71 FR 41392	07/21/2006

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 41616	07/21/2006
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Annual Information Return/Report	5500, 5500-SF	Annual Return/Report of Employee Benefit Plan ,   Short Form Annual Return/Report of Small Employee Benefit Plan

---

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	30,300	28,900	0	0	1,400	0
Annual Time Burden (Hours)	1,800	2,373	-400	0	-173	0
Annual Cost Burden (Dollars)	1,600,000	1,737,000	-200,000	0	63,000	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: The Pension Protection Act of 2006 required a simplified reporting alternative for certain small plans, which resulted in a decrease in the hour and cost burdens. (Program Change Due to New Statute.) The Department of Labor (Employee Benefits Security Administration) updated the model that is used for these burden calculations and used updated estimates of the number of plans affected by the regulation, which resulted in a slight decrease in the hour burden and a slight increase in the cost burden. (Change Due to Adjustment in Agency Estimate.)

---

Annual Cost to Federal Government: $400,000

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: 07/17/2007

---