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Annual Information Return/Report
Annual Information Return/Report
OMB: 1212-0057
IC ID: 13607
OMB.report
PBGC
OMB 1212-0057
ICR 201006-1212-005
IC 13607
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0057 can be found here:
2024-04-03 - No material or nonsubstantive change to a currently approved collection
2023-02-27 - Revision of a currently approved collection
Documents and Forms
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:
Document Type
Form No.
Form Name
Instrument File
URL
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
30,300
0
0
0
0
30,300
Annual IC Time Burden (Hours)
1,200
0
0
0
0
1,200
Annual IC Cost Burden (Dollars)
1,250,000
0
0
0
0
1,250,000
Documents for IC
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.