Information Collection

Termination of Single Employer Plans

IC 13567 under ICR 200708-1212-001 · OMB 1212-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0036 can be found here:

2026-07-07 - No material or nonsubstantive change to a currently approved collection
2026-06-04 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PBGC Form 500 Standard Termination Notice Single-Employer Plan Termination Termination of Single Employer Plans	Form
Form PBGC Form 501 Post-Distribution Certification for Standard Termination Termination of Single Employer Plans	Form
Form PBGC Schedule REP- Standard Termination Designation of Representative Termination of Single Employer Plans	Form
Form PBGC Schedule EA-S Standard Termination Certification of Sufficiency Termination of Single Employer Plans	Form
Form PBGC Form 600 Distress Terminaton Notice of Intent to Terminate Termination of Single Employer Plans	Form
Form PBGC Schedule REP- Distress Termination Designation of Representative Termination of Single Employer Plans	Form
Form PBGC Form 601 Distress Termination Notice Single-Employer Plan Termination Termination of Single Employer Plans	Form
Form PBGC Schedule EA-D Distress Termination Enrolled Actuary Certification Termination of Single Employer Plans	Form
Form PBGC Form 602 Post-Distribution Certification for Distress Termination Termination of Single Employer Plans	Form
Form Schedule MP Missing Participant Information Termination of Single Employer Plans	Form
Form Attachment A (to S Missing Participant Annuity Purchase Information Termination of Single Employer Plans	Form
Form Attachment B (to S Missing Participant Individual Information Termination of Single Employer Plans	Form
Form Payment Voucher (t Missing Participant Payment Voucher Termination of Single Employer Plans	Form
Standard Termination Instructions 2007.pdf	Instruction
Distress Termination Instructions 2007.pdf	Instruction
Missing Participants Instructions -- 2007.pdf	Instruction
PBGC Form 500 Standard Termination Notice Single-Employer Plan Termina PBGC Form 500 -- 2007.pdf	Form
PBGC Form 501 Post-Distribution Certification for Standard Termination PBGC Form 501 -- 2007.pdf	Form
PBGC Schedule REP- Standard Termination Designation of Representative PBGC Schedule REP-S -- 2007.pdf	Form
PBGC Schedule EA-S Standard Termination Certification of Sufficiency PBGC Schedule EA-S -- 2007.pdf	Form
PBGC Form 600 Distress Terminaton Notice of Intent to Terminate PBGC Form 600 -- 2007.pdf	Form
PBGC Schedule REP- Distress Termination Designation of Representative PBGC Schedule REP-D -- 2007.pdf	Form
PBGC Form 601 Distress Termination Notice Single-Employer Plan Termina PBGC Form 601 -- 2007.pdf	Form
PBGC Schedule EA-D Distress Termination Enrolled Actuary Certification PBGC Schedule EA-D -- 2007.pdf	Form
PBGC Form 602 Post-Distribution Certification for Distress Termination PBGC Form 602 -- 2007.pdf	Form
Schedule MP Missing Participant Information Schedule MP -- 2007.pdf	Form
Attachment A (to S Missing Participant Annuity Purchase Information Missing Participants Attachment A -- 2007.pdf	Form
Attachment B (to S Missing Participant Individual Information Missing Participants Attachment B -- 2007.pdf	Form
Payment Voucher (t Missing Participant Payment Voucher Missing Participant Payment Voucher -- 2007.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Termination of Single Employer Plans

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4041 29 CFR 4050

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PBGC Form 500	Yes	No	Printable Only
Instruction		Yes	No	Printable Only
Form	PBGC Form 501	Yes	No	Printable Only
Form	PBGC Schedule REP-S	Yes	No	Printable Only
Form	PBGC Schedule EA-S	Yes	No	Printable Only
Instruction		Yes	No	Printable Only
Form	PBGC Form 600	Yes	No	Printable Only
Form	PBGC Schedule REP-D	Yes	No	Printable Only
Form	PBGC Form 601	Yes	No	Printable Only
Form	PBGC Schedule EA-D	Yes	No	Printable Only
Form	PBGC Form 602	Yes	No	Printable Only
Instruction		Yes	No	Printable Only
Form	Schedule MP	Yes	No	Printable Only
Form	Attachment A (to Schedule MP)	Yes	No	Printable Only
Form	Attachment B (to Schedule MP)	Yes	No	Printable Only
Form	Payment Voucher (to Schedule MP)	Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,259

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,259	84	1,175
Annual IC Time Burden (Hours)	2,081	338	1,743
Annual IC Cost Burden (Dollars)	2,766,679	793,679	1,973,000

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.

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