Annual Information Return/Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
IRS Notice 2011-3.pdf	Supplementary Document	Uploaded 2010-12-29	Available
IRS Notice 2010-83.pdf	Supplementary Document	Uploaded 2010-12-09	Available
PBGC_2011F5500ssAmended clfin.122010.docx	Supporting Statement A	Uploaded 2010-12-20	Available
ScheduleRTechUpdate 2OGC.docx	Supplementary Document	Uploaded 2010-05-20	Available
Justification for nonmaterial nonsubstantive changeL14ScR5-20-2010.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2010-05-20	Available
Attachment D - 2009 Forms and Schedules.pdf	Supplementary Document	Uploaded 2009-09-16	Available
2009-2010 Justification for nonmaterial nonsubstantive change.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-09-16	Available
Attachment D - 2010 Forms and Schedules.pdf	Supplementary Document	Uploaded 2009-09-15	Available
PBGC 2010 PRA Numbers.xls	Supplementary Document	Uploaded 2009-09-01	Available
PBGC 2009 PRA Numbers.xls	Supplementary Document	Uploaded 2009-09-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13607	Annual Information Return/Report	Instruction	Modified

ICR Details

OMB Control No: 1212-0057	ICR Reference No: 201006-1212-005
Status: Historical Active	Previous ICR Reference No: 201005-1212-001
Agency/Subagency: PBGC	Agency Tracking No:
Title: Annual Information Return/Report
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/25/2011
	Date Received in OIRA: 09/17/2010
Terms of Clearance: Approved consistent with PBGC revisions.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	36 Months From Approved	04/30/2011
Responses	30,300	0	30,300
Time Burden (Hours)	1,200	0	1,200
Cost Burden (Dollars)	1,250,000	0	1,250,000

---

Abstract: Sections 104 and 4065 of ERISA require plan administrators to file an annual report. The report must contain the information described in section 103 of ERISA. The Form 5500 Series provides a standard format for fulfilling that requirement.

---

Authorizing Statute(s): US Code: 29 USC 1302(b)(3), 1365 Name of Law: ERISA
  

Citations for New Statutory Requirements: Statute at Large: 120 Stat. 780 Name of Statute: Pension Protection Act of 2006

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB06	Final or interim final rulemaking	71 FR 41392	07/21/2006

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 36127	06/24/2010
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Annual Information Return/Report	2010 5500 and 2010 5500-SF, 2009 5500 and 2010 5500-SF, 2009 Form 5500 , 2009 Schedule I, 2009 Schedule R, 2010 Schedule C, 2010 Schedule G, 2010 Schedule I, 2010 Schedule R, 2010 Schedule H, 2010 Schedule D, 2010 Schedule MB, 2009 Schedule C , 2009 Schedule H, 2009 Schedule G, 2009 Schedule MB, 2010 Schedule A, 2010 Form 5500-SF, 2009 Schedule SB, 2010 Form 5500, 2010 Schedule SB, 2009 Schedule D, 2009 Schedule A, 2009 Form 5500-SF	2010 Form 5500-SF Screen Shot ,   2010 Schedule SB Screen Shot ,   2009 Schedule A Screen Shot ,   2009 Schedule D Screen Shot ,   2009 Schedule I Screen Shot ,   2009 Schedule R Screen Shot ,   2010 Schedule G Screen Shot ,   2010 Schedule I Screen Shot ,   2010 Schedule R Screen Shot ,   2010 Schedule C Screen Shot ,   2009 Form 5500-SF Screen Shot ,   2009 Form 5500 Screen Shot ,   2010 Schedule D Screen Shot ,   2010 Schedule H Screen Shot ,   2010 Schedule MB Screen Shot ,   2009 Schedule C Screen Shot ,   2009 Schedule MB Screen Shot ,   2009 Schedule G Screen Shot ,   2009 Schedule H Screen Shot ,   2009 Schedule SB Screen Shot ,   2010 Form 5500 Screen Shot ,   2010 Schedule A Screen Shot ,   2010 Annual Return/Report of Employee Benefit Plan and 2010 Short Form Annual Return/Report of Small Employee Benefit Plan ,   2009 Annual Return/Report of Employee Benefit Plan and 2009 Short Form Annual Return/Report of Small Employee Benefit Plan

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	30,300	30,300	0	0	0	0
Annual Time Burden (Hours)	1,200	1,200	0	0	0	0
Annual Cost Burden (Dollars)	1,250,000	1,250,000	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $671,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/17/2010

---