Information Collection

Reportable Events

IC 13522 under ICR 200901-1212-006 · OMB 1212-0013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0013 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10 Post-Event Notice of Reportable Events Reportable Events	Form
Form Form 10-Advance Advance Notice of Reportable Event Reportable Events	Form
Form 10 Instr._Markup for 2009_(3 yr rollover)_to OMB.pdf	Instruction
Form 10 ADV Instr._Markup for 2009_(3 yr rollover)_to OMB.pdf	Instruction
10 Post-Event Notice of Reportable Events Form 10.pdf	Form
Form 10-Advance Advance Notice of Reportable Event Form 10 ADV.pdf	Form

IC Title:

Reportable Events

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10	Yes	Yes	Paper Only
Instruction		Yes	Yes	Paper Only
Form	Form 10-Advance	Yes	Yes	Paper Only
Instruction		Yes	Yes	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 637

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	637	-68	705
Annual IC Time Burden (Hours)	2,676	-298	2,974
Annual IC Cost Burden (Dollars)	936,600	119,600	817,000

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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