Information Collection

Section 4062(e) Event Notice

IC 192214 under ICR 201003-1212-001 · OMB 1212-0070.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4062-E Section 4062(e) Event Notice	Form and Instruction
4062-E Section 4062(e) Event Notice Package 4062-E ppsd.d10.pdf	Form and Instruction
4062-E Section 4062(e) Event Notice Form 4062-E ppsd.d10.fillable.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4062

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	4062-E	Section 4062(e) Event Notice	Package 4062-E ppsd.d10.pdf		Yes	No	Printable Only
Form	4062-E	Section 4062(e) Event Notice	Form 4062-E ppsd.d10.fillable.pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 4

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	1,400	1,400
Annual IC Cost Burden (Dollars)	490,000	490,000

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.