Qualified Domestic Relations Orders submitted to the PBGC

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.