Information Collection

Annual Information Return/Report

IC 13607 under ICR 201006-1212-005 · OMB 1212-0057.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0057 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2010 Schedule SB as of 033110.pdf	Instruction
Instructions for Schedule MB 04092010.pdf	Instruction
2010 5500 and 2010 2010 Annual Return/Report of Employee Benefit Plan and 2 Attachment D - 2010 Forms and Schedules.pdf	Form
2009 5500 and 2010 2009 Annual Return/Report of Employee Benefit Plan and 2 Attachment D - 2009 Forms and Schedules.pdf	Form
2009 Form 5500 2009 Form 5500 Screen Shot 2009 Form 5500ScreenShot.pdf	Form
2009 Form 5500-SF 2009 Form 5500-SF Screen Shot 2009 Form 5500 SFScreenShot.pdf	Form
2009 Schedule A 2009 Schedule A Screen Shot 2009 Sch AScreenShot.pdf	Form
2009 Schedule C 2009 Schedule C Screen Shot 2009 Sch CScreenShot.pdf	Form
2009 Schedule D 2009 Schedule D Screen Shot 2009 Sch DScreenShot.pdf	Form
2009 Schedule G 2009 Schedule G Screen Shot 2009 Sch GScreenShot.pdf	Form
2009 Schedule H 2009 Schedule H Screen Shot 2009 Sch HScreenShot.pdf	Form
2009 Schedule I 2009 Schedule I Screen Shot 2009 Sch IScreenShot.pdf	Form
2009 Schedule MB 2009 Schedule MB Screen Shot 2009 Sch MBScreenShot.pdf	Form
2009 Schedule R 2009 Schedule R Screen Shot 2009 Sch RScreenShot.pdf	Form
2009 Schedule SB 2009 Schedule SB Screen Shot 2009 Sch SBScreenShot.pdf	Form
2010 Form 5500 2010 Form 5500 Screen Shot 2010 Form 5500ScreenShot.pdf	Form
2010 Form 5500-SF 2010 Form 5500-SF Screen Shot 2010 Form 5500 SFScreenShot.pdf	Form
2010 Schedule A 2010 Schedule A Screen Shot 2010 Sch AScreenShot.pdf	Form
2010 Schedule C 2010 Schedule C Screen Shot 2010 Sch CScreenShot.pdf	Form
2010 Schedule D 2010 Schedule D Screen Shot 2010 Sch DScreenShot.pdf	Form
2010 Schedule G 2010 Schedule G Screen Shot 2010 Sch GScreenShot.pdf	Form
2010 Schedule H 2010 Schedule H Screen Shot 2010 Sch HScreenShot.pdf	Form
2010 Schedule I 2010 Schedule I Screen Shot 2010 Sch IScreenShot.pdf	Form
2010 Schedule MB 2010 Schedule MB Screen Shot 2010 Sch MBScreenShot.pdf	Form
2010 Schedule R 2010 Schedule R Screen Shot 2010 Sch RScreenShot.pdf	Form
2010 Schedule SB 2010 Schedule SB Screen Shot 2010 Sch SBScreenShot.pdf	Form
Justification for nonmaterial nonsubstantive changembsb04-12-2010.doc Justification for Non-material/Non-substantive Change	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Annual Information Return/Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4065

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
Instruction			2010 Schedule SB as of 033110.pdf	Yes	Yes	Fillable Fileable
Instruction			Instructions for Schedule MB 04092010.pdf	Yes	Yes	Fillable Fileable
Form	2010 Form 5500-SF	2010 Form 5500-SF Screen Shot	2010 Form 5500 SFScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 Schedule SB	2010 Schedule SB Screen Shot	2010 Sch SBScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Schedule A	2009 Schedule A Screen Shot	2009 Sch AScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Schedule D	2009 Schedule D Screen Shot	2009 Sch DScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Schedule I	2009 Schedule I Screen Shot	2009 Sch IScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Schedule R	2009 Schedule R Screen Shot	2009 Sch RScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 Schedule G	2010 Schedule G Screen Shot	2010 Sch GScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 Schedule I	2010 Schedule I Screen Shot	2010 Sch IScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 Schedule R	2010 Schedule R Screen Shot	2010 Sch RScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 Schedule C	2010 Schedule C Screen Shot	2010 Sch CScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Form 5500-SF	2009 Form 5500-SF Screen Shot	2009 Form 5500 SFScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Form 5500	2009 Form 5500 Screen Shot	2009 Form 5500ScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 Schedule D	2010 Schedule D Screen Shot	2010 Sch DScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 Schedule H	2010 Schedule H Screen Shot	2010 Sch HScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 Schedule MB	2010 Schedule MB Screen Shot	2010 Sch MBScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Schedule C	2009 Schedule C Screen Shot	2009 Sch CScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Schedule MB	2009 Schedule MB Screen Shot	2009 Sch MBScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Schedule G	2009 Schedule G Screen Shot	2009 Sch GScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Schedule H	2009 Schedule H Screen Shot	2009 Sch HScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2009 Schedule SB	2009 Schedule SB Screen Shot	2009 Sch SBScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 Form 5500	2010 Form 5500 Screen Shot	2010 Form 5500ScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 Schedule A	2010 Schedule A Screen Shot	2010 Sch AScreenShot.pdf	Yes	Yes	Fillable Fileable
Form	2010 5500 and 2010 5500-SF	2010 Annual Return/Report of Employee Benefit Plan and 2010 Short Form Annual Return/Report of Small Employee Benefit Plan	Attachment D - 2010 Forms and Schedules.pdf	Yes	Yes	Fillable Fileable
Form	2009 5500 and 2010 5500-SF	2009 Annual Return/Report of Employee Benefit Plan and 2009 Short Form Annual Return/Report of Small Employee Benefit Plan	Attachment D - 2009 Forms and Schedules.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,300

Number of Respondents for Small Entity: 18,300

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 1 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30,300	30,300
Annual IC Time Burden (Hours)	1,200	1,200
Annual IC Cost Burden (Dollars)	1,250,000	1,250,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification for Non-material/Non-substantive Change	Justification for nonmaterial nonsubstantive changembsb04-12-2010.doc	04/12/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.