Information Collection

Termination of Single Employer Plans

IC 13567 under ICR 200711-1212-009 · OMB 1212-0036.

⚠️ Notice: This information collection may be referencing outdated material.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

2026-06-04 - No material or nonsubstantive change to a currently approved collection
2026-02-27 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Form PBGC Form 500 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: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4041 29 CFR 4050

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PBGC Form 500	Standard Termination Notice Single-Employer Plan Termination	PBGC Form 500 -- 2007.pdf	Yes	No	Printable Only
Instruction			Standard Termination Instructions 2007.pdf	Yes	No	Printable Only
Form	PBGC Form 501	Post-Distribution Certification for Standard Termination	PBGC Form 501 -- 2007.pdf	Yes	No	Printable Only
Form	PBGC Schedule REP-S	Standard Termination Designation of Representative	PBGC Schedule REP-S -- 2007.pdf	Yes	No	Printable Only
Form	PBGC Schedule EA-S	Standard Termination Certification of Sufficiency	PBGC Schedule EA-S -- 2007.pdf	Yes	No	Printable Only
Instruction			Distress Termination Instructions 2007.pdf	Yes	No	Printable Only
Form	PBGC Form 600	Distress Terminaton Notice of Intent to Terminate	PBGC Form 600 -- 2007.pdf	Yes	No	Printable Only
Form	PBGC Schedule REP-D	Distress Termination Designation of Representative	PBGC Schedule REP-D -- 2007.pdf	Yes	No	Printable Only
Form	PBGC Form 601	Distress Termination Notice Single-Employer Plan Termination	PBGC Form 601 -- 2007.pdf	Yes	No	Printable Only
Form	PBGC Schedule EA-D	Distress Termination Enrolled Actuary Certification	PBGC Schedule EA-D -- 2007.pdf	Yes	No	Printable Only
Form	PBGC Form 602	Post-Distribution Certification for Distress Termination	PBGC Form 602 -- 2007.pdf	Yes	No	Printable Only
Instruction			Missing Participants Instructions -- 2007.pdf	Yes	No	Printable Only
Form	Schedule MP	Missing Participant Information	Schedule MP -- 2007.pdf	Yes	No	Printable Only
Form	Attachment A (to Schedule MP)	Missing Participant Annuity Purchase Information	Missing Participants Attachment A -- 2007.pdf	Yes	No	Printable Only
Form	Attachment B (to Schedule MP)	Missing Participant Individual Information	Missing Participants Attachment B -- 2007.pdf	Yes	No	Printable Only
Form	Payment Voucher (to Schedule MP)	Missing Participant Payment Voucher	Missing Participant Payment Voucher -- 2007.pdf	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,259	1,259
Annual IC Time Burden (Hours)	2,081	2,081
Annual IC Cost Burden (Dollars)	2,766,679	2,766,679

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.