Information Collection

Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) - pre-PPA

IC 13583 under ICR 200802-1212-012 · OMB 1212-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0049 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) - pre-PPA	Form and Instruction
Appendix 2 - Instructions.doc	Instruction
Appendix 2 - Instructions.doc	Instruction
4010 screen shots (pre-PPA) Appendix 1 - Screen Shots.pdf	Form and Instruction
4010 (pre-PPA) Appendix 3 - Form.doc	Form
4010 (PPA) Appendix 3 - Form.doc	Form

IC Title:

Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) - pre-PPA

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	4010 screen shots (pre-PPA)	Appendix 1 - Screen Shots.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			Appendix 2 - Instructions.doc	Yes	Yes	Fillable Fileable Signable
Form	NA	4010 (pre-PPA)	Appendix 3 - Form.doc	Yes	Yes	Fillable Fileable Signable
Instruction			Appendix 2 - Instructions.doc	Yes	Yes	Fillable Fileable Signable
Form	N/A	4010 (PPA)	Appendix 3 - Form.doc	Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	300	-100	400
Annual IC Time Burden (Hours)	2,600	-880	3,480
Annual IC Cost Burden (Dollars)	5,167,500	-332,500	5,500,000

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.