Annual Information Return/Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form 5500 Annual Return/Report of Employee Benefit Plan	Form	Modified	Available
Form 2009 Form 5500-SF Short Form Annual Return/Report of Small Employee	Form	Modified	Available
Form 2010 Form 5500 and Annual Return/Report of Employee Benefit Plan and Short Form Annual Return/Report of Small Employee	Form	Modified	Available
Justification for nonmaterial nonsubstantive change09.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-09-16	Available
2009F5500ss07_06_11_2007_FINAL.doc	Supporting Statement A	Uploaded 2009-09-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13467	Annual Information Return/Report	Form	Modified	Annual Return/Report of Employee Benefit Plan
13467	Annual Information Return/Report	Form	Modified	Short Form Annual Return/Report of Small Employee
13467	Annual Information Return/Report	Instruction	Modified
13467	Annual Information Return/Report	Form	Modified	Annual Return/Report of Employee Benefit Plan and Short Form Annual Return/Report of Small Employee

ICR Details

OMB Control No: 1210-0110	ICR Reference No: 200907-1210-001
Status: Historical Active	Previous ICR Reference No: 200807-1210-003
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Annual Information Return/Report
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: 11/06/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/25/2009
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	780,000	0	780,000
Time Burden (Hours)	530,000	0	521,000
Cost Burden (Dollars)	178,000,000	0	190,000,000

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Abstract: Section 104 and 4065 of ERISA require plan administrators to file an annual report containing the information described in section 103 of ERISA. The Form 5500 provides a standard format for fulfilling that requirement.

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Authorizing Statute(s): US Code: 29 USC 1023 Name of Law: Employee Retirement Income Security Act of 1974
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 280 1103(b) Name of Law: Pension Protection Act of 2006

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB06	Final or interim final rulemaking	72 FR 64709	11/16/2007

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 41392	07/21/2006
Did the Agency receive public comments on this ICR? Yes

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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
Annual Information Return/Report	2009 Form 5500-SF, Form 5500, 2010 Form 5500 and 2010 Form 5500-SF	Annual Return/Report of Employee Benefit Plan and Short Form Annual Return/Report of Small Employee ,   Short Form Annual Return/Report of Small Employee ,   Annual Return/Report of Employee Benefit Plan

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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	780,000	780,000	0	0	0	0
Annual Time Burden (Hours)	530,000	521,000	0	9,000	0	0
Annual Cost Burden (Dollars)	178,000,000	190,000,000	0	-12,000,000	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The main difference from the 2008 Forms are: (a) all forms will be required to be filed electronically; (b) Schedule E and Schedule SSA will be removed; (c) the new Short Form 5500 (5500-SF) will be established; (d) the special limited reporting rules for Code section 403(b) plans will be eliminated; (e) Schedule C will be revised; (f) additional data elements will be added to Schedule R; and (g) various smaller technical revisions will be made to the Schedule A, Schedule H, and Schedule I. There will be no change between the 2009 and 2010 forms and burden.

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Annual Cost to Federal Government: $8,200,000

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)? No

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: 09/25/2009

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