Information Collection

Qualified Domestic Relations Orders submitted to the PBGC

IC 43802 under ICR 200907-1212-001 · OMB 1212-0054.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0054 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
QDRO Booklet 7-2009 Final.doc	Instruction
RE PBGC PRA submission.htm; control number1212-0054.htm Email outlining changes resulting from DOL/ IRS comments	IC Document

IC Title:

Qualified Domestic Relations Orders submitted to the PBGC

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			QDRO Booklet 7-2009 Final.doc		Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 895

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	895	20	875
Annual IC Time Burden (Hours)	2,105	1,264	841
Annual IC Cost Burden (Dollars)	495,060	-73,943	569,003

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email outlining changes resulting from DOL/ IRS comments	RE PBGC PRA submission.htm; control number1212-0054.htm	08/10/2006

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.