Information Collection

Annual Registration Statement Identifying Separated Participants with Deferred Vested Benefits

IC 9597 under ICR 200708-0960-012 · OMB 0960-0606.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
IEA IRS-SSA.doc	Other-Information Exchange Agreement
Attachment A.doc	Other-IRS's Privacy Safeguards, Disc
Attachment B.doc	Other-IRS Requirements on Behalf of
Attachment C - IRS EPMF Extract File for SSA.doc	Other-IRS EPMF Extract File for SSA
2007 Instructions for Schedule SSA.pdf	Instruction
EFAST & Paper Instructions for Form 5500.pdf	Instruction
Signed IEA IRS-SSA 11-07.doc	Other-MOU/IEA Agreement
Form 5500 (IRS For Annual Registration Statement Identifying Separated Part Schedule SSA Form.pdf www.efast.dol.gov/	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

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-Information Exchange Agreement			IEA IRS-SSA.doc		Yes	Yes	Fillable Fileable Signable
Other-IRS's Privacy Safeguards, Disclosure Safeguards, Record Retention and Security			Attachment A.doc		No		Printable Only
Other-IRS Requirements on Behalf of SSA with DOL's Processing Contract			Attachment B.doc		No		Printable Only
Other-IRS EPMF Extract File for SSA (sample)			Attachment C - IRS EPMF Extract File for SSA.doc		Yes	Yes	Fillable Fileable Signable
Form	Form 5500 (IRS Form)	Annual Registration Statement Identifying Separated Participants with Deferred Vested Benefits (Schedule SSA)	Schedule SSA Form.pdf	http://www.efast.dol.gov/	Yes	Yes	Fillable Fileable Signable
Instruction			2007 Instructions for Schedule SSA.pdf		Yes	No	Printable Only
Instruction			EFAST & Paper Instructions for Form 5500.pdf		Yes	Yes	Printable Only
Other-MOU/IEA Agreement			Signed IEA IRS-SSA 11-07.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 88,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	88,000	88,000
Annual IC Time Burden (Hours)	220,000	220,000
Annual IC Cost Burden (Dollars)	12,194,000	12,194,000

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.