Information Collection

428 PBGC Premium Filer Q's 2011 F, 429 VBA 2011 Insurance Claims Q's F, 430 VBA 2011 Call Center Q's F

IC 197228 under ICR 200908-1090-001 · OMB 1090-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 428 PBGC Premium F 428 PBGC Premium Filer Q's 2011 F, 429 VBA 2011 Insurance Claims Q's F, 430 VBA 2011 Call Center Q's F	Form
428 PBGC Premium F 428 PBGC Premium Filer Q's 2011 F 2011 428 PBGC Premium Filer Questionnaire 2011 FINAL.DOC	Form
429 VBA 2011 Insur 429 VBA 2011 Insurance Claims Q's Final 2011 429 VBA 2011 Insurance Claims Questionnaire Final.docx	Form
430 VBA 2011 Call 430 VBA 2011 Call Center Q's Final 2011 430 VBA 2011 Call Center Questionnaire Final.docx	Form

IC Title:

428 PBGC Premium Filer Q's 2011 F, 429 VBA 2011 Insurance Claims Q's F, 430 VBA 2011 Call Center Q's F

Agency IC Tracking Number:

428-430

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	428 PBGC Premium Filer Q's 2011 F	428 PBGC Premium Filer Q's 2011 F	2011 428 PBGC Premium Filer Questionnaire 2011 FINAL.DOC	No	Paper Only
Form	429 VBA 2011 Insurance Claims Q's Final	429 VBA 2011 Insurance Claims Q's Final	2011 429 VBA 2011 Insurance Claims Questionnaire Final.docx	No	Paper Only
Form	430 VBA 2011 Call Center Q's Final	430 VBA 2011 Call Center Q's Final	2011 430 VBA 2011 Call Center Questionnaire Final.docx	No	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

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.