Termination of Single Employer Plans

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Payment Voucher (t Missing Participant Payment Voucher	Form	Unchanged	Available
Form Attachment B (to S Missing Participant Individual Information	Form	Unchanged	Available
Form Attachment A (to S Missing Participant Annuity Purchase Information	Form	Unchanged	Available
Form Schedule MP Missing Participant Information	Form	Unchanged	Available
Form PBGC Form 602 Post-Distribution Certification for Distress Termination	Form	Unchanged	Available
Form PBGC Schedule EA-D Distress Termination Enrolled Actuary Certification	Form	Unchanged	Available
Form PBGC Schedule REP- Distress Termination Designation of Representative	Form	Unchanged	Available
Form PBGC Form 600 Distress Terminaton Notice of Intent to Terminate	Form	Unchanged	Available
Form PBGC Schedule EA-S Standard Termination Certification of Sufficiency	Form	Unchanged	Available
Form PBGC Schedule REP- Standard Termination Designation of Representative	Form	Unchanged	Available
Form PBGC Form 501 Post-Distribution Certification for Standard Termination	Form	Unchanged	Available
Form PBGC Form 500 Standard Termination Notice Single-Employer Plan Termination	Form	Unchanged	Available
Form PBGC Form 601 Distress Termination Notice Single-Employer Plan Termination	Form	Unchanged	Available
Justification.TechUpdate08-4.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2008-11-24	Available
TechUpdate08-3.2OMB.doc	Supplementary Document	Uploaded 2008-11-24	Available
Justification 4041PRA.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2007-11-26	Available
TechUpdate 07-3 lump sum guidance - To OMB.doc	Supplementary Document	Uploaded 2007-11-26	Available
Supporting Statement 2007.pdf	Supporting Statement A	Uploaded 2007-08-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13567	Termination of Single Employer Plans	Form	Unchanged	Missing Participant Payment Voucher
13567	Termination of Single Employer Plans	Form	Unchanged	Missing Participant Individual Information
13567	Termination of Single Employer Plans	Form	Unchanged	Missing Participant Annuity Purchase Information
13567	Termination of Single Employer Plans	Form	Unchanged	Missing Participant Information
13567	Termination of Single Employer Plans	Form	Unchanged	Post-Distribution Certification for Distress Termination
13567	Termination of Single Employer Plans	Form	Unchanged	Distress Termination Enrolled Actuary Certification
13567	Termination of Single Employer Plans	Form	Unchanged	Distress Termination Designation of Representative
13567	Termination of Single Employer Plans	Form	Unchanged	Distress Terminaton Notice of Intent to Terminate
13567	Termination of Single Employer Plans	Form	Unchanged	Standard Termination Certification of Sufficiency
13567	Termination of Single Employer Plans	Form	Unchanged	Standard Termination Designation of Representative
13567	Termination of Single Employer Plans	Form	Unchanged	Post-Distribution Certification for Standard Termination
13567	Termination of Single Employer Plans	Instruction	Unchanged
13567	Termination of Single Employer Plans	Form	Unchanged	Standard Termination Notice Single-Employer Plan Termination
13567	Termination of Single Employer Plans	Form	Unchanged	Distress Termination Notice Single-Employer Plan Termination

ICR Details

OMB Control No: 1212-0036	ICR Reference No: 200811-1212-001
Status: Historical Active	Previous ICR Reference No: 200711-1212-009
Agency/Subagency: PBGC	Agency Tracking No:
Title: Termination of Single Employer Plans
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/09/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/24/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2010	09/30/2010	09/30/2010
Responses	1,259	0	1,259
Time Burden (Hours)	2,081	0	2,081
Cost Burden (Dollars)	2,766,679	0	2,766,679

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Abstract: Plan administrators of plans terminating voluntarily must submit certain information to the PBGC and provide certain information to affected third parties. The PBGC needs the information required to be submitted to ensure that a voluntary termination if completed in accordance with statutory and regulatory requirements and to facilitate the payment of benefits to missing participants. Participants need the information required to be disclosed so that they will be informed about the status of the proposed termination of their plan and about their benefits upon termination.

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Authorizing Statute(s): US Code: 29 USC 1350
   US Code: 29 USC 1341
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 27596	05/16/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 46109	08/16/2007
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Termination of Single Employer Plans	PBGC Schedule REP-D, PBGC Form 600, PBGC Form 602, PBGC Form 601, Attachment A (to Schedule MP), Schedule MP, PBGC Form 501, PBGC Schedule REP-S, PBGC Schedule EA-S, Payment Voucher (to Schedule MP), PBGC Form 500, Attachment B (to Schedule MP), PBGC Schedule EA-D	Standard Termination Notice Single-Employer Plan Termination ,   Post-Distribution Certification for Standard Termination ,   Standard Termination Designation of Representative ,   Standard Termination Certification of Sufficiency ,   Distress Terminaton Notice of Intent to Terminate ,   Distress Termination Designation of Representative ,   Distress Termination Notice Single-Employer Plan Termination ,   Distress Termination Enrolled Actuary Certification ,   Post-Distribution Certification for Distress Termination ,   Missing Participant Information ,   Missing Participant Annuity Purchase Information ,   Missing Participant Individual Information ,   Missing Participant Payment Voucher

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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	1,259	1,259	0	0	0	0
Annual Time Burden (Hours)	2,081	2,081	0	0	0	0
Annual Cost Burden (Dollars)	2,766,679	2,766,679	0	0	0	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:

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Annual Cost to Federal Government: $408,124

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

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Common Form ICR:  No

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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: 11/24/2008

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