Information Collection

495 - 496 DOJ JAG Survey and PBGC Premium Filer

IC 201756 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⚠️ Notice: This information collection may be referencing outdated material.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 495 DOJ 495 - 496 DOJ JAG Survey and PBGC Premium Filer	Form and Instruction
495 DOJ 495 DOJ JAG Questionnaire Final 3-30-12 2012 495 DOJ JAG Questionnaire Final 3-30-12.docx	Form and Instruction
496 PBGC 496 PBGC Premium Filer Questionnaire 2012 Final.doc 2012 496 PBGC Premium Filer Questionnaire 2012 FINAL.DOC	Form and Instruction

IC Title:

495 - 496 DOJ JAG Survey and PBGC Premium Filer

Agency IC Tracking Number:

495 - 496

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	495 DOJ	495 DOJ JAG Questionnaire Final 3-30-12	2012 495 DOJ JAG Questionnaire Final 3-30-12.docx		Yes	Yes	Fillable Fileable
Form and Instruction	496 PBGC	496 PBGC Premium Filer Questionnaire 2012 Final.doc	2012 496 PBGC Premium Filer Questionnaire 2012 FINAL.DOC		No		Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	108	108
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.