Information Collection

Reportable Events

IC 13522 under ICR 200911-1212-002 · OMB 1212-0013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0013 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10 Reportable Events	Form
Form 10 Instructions_Proposed Rule_to OMB 11_09.pdf	Instruction
Form 10 ADV Instructions_Proposed Rule_to OMB 11_09.pdf	Instruction
10 Post-Event Notice of Reportable Events FORM 10_Proposed Rule_to OMB 11_09.pdf	Form
Form 10-Advance Advance Notice of Reportable Event FORM 10-ADVANCE_Proposed Rule_to OMB 11_09.pdf	Form

IC Title:

Reportable Events

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4043

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10	Post-Event Notice of Reportable Events	FORM 10_Proposed Rule_to OMB 11_09.pdf	Yes	Yes	Paper Only
Instruction			Form 10 Instructions_Proposed Rule_to OMB 11_09.pdf	Yes	Yes	Paper Only
Form	Form 10-Advance	Advance Notice of Reportable Event	FORM 10-ADVANCE_Proposed Rule_to OMB 11_09.pdf	Yes	Yes	Paper Only
Instruction			Form 10 ADV Instructions_Proposed Rule_to OMB 11_09.pdf	Yes	Yes	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,200	1,563	637
Annual IC Time Burden (Hours)	13,500	10,824	2,676
Annual IC Cost Burden (Dollars)	4,620,000	3,683,400	936,600

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.