Locating and Paying Participants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form 716A Certification of Pension Plan Disability Status	Form and Instruction	Modified	Available
Form Form 712 Uniformed Services Information Form	Form and Instruction	Modified	Available
Form Form 716 Certification of Social Security Disability Status	Form and Instruction	Modified	Available
Form Form 704 Request for Earnings Information	Form and Instruction	Modified	Available
Form 722 Financial Statement of Debtor	Form and Instruction	Modified	Available
Form 721 Application for Lump-Sum Payment -- Non-spouse Beneficiary or Estate	Form and Instruction	Modified	Available
Form 720MP Application for Lum-Sum Payment	Form and Instruction	Modified	Available
Form 720CD Application for Lump-Sum Payment	Form and Instruction	Modified	Available
Form 720 Application for Lump-Sum Payment	Form and Instruction	Modified	Available
Form 719 Election to Withhold Federal Income Tax from Periodic Payments	Form and Instruction	Modified	Available
Form 718 Installment Payment Agreement	Form and Instruction	Modified	Available
Form 717 Monthly Payment Election Form	Form and Instruction	Modified	Available
Form 715 Power of Attorney (POA)	Form and Instruction	Modified	Available
Form 714 Application for Payment of Employee Contributions -- Non-Spouse Beneficiary	Form and Instruction	Modified	Available
Form 713 Application for Payment of Employee Contributions	Form and Instruction	Modified	Available
Form 711 Change of Beneficiary for Certain & Continuous (C&C) Benefits Only	Form and Instruction	Modified	Available
Form 710 Application for Electronic Direct Deposit	Form and Instruction	Modified	Available
Form 709 Plan Participation Information	Form and Instruction	Modified	Available
Form 708 Designation of Beneficiary	Form and Instruction	Modified	Available
Form 707 Designation of Beneficiary for Benefits Owed at Death	Form and Instruction	Modified	Available
Form 706 Beneficiary Application for Pension Benefits -- OF	Form and Instruction	Modified	Available
Form 705 Beneficiary Application for Pension Benefits	Form and Instruction	Modified	Available
Form 703MP Application for Elective Lump-Sum Payment	Form and Instruction	Modified	Available
Form 703 Application for Elective Lump-Sum Payment	Form and Instruction	Modified	Available
Form 702 General Information Form	Form and Instruction	Modified	Available
Form 701 Payee Information Form	Form and Instruction	Modified	Available
Form 700 Participant Application for Pension Benefits	Form and Instruction	Modified	Available
Supporting statement 2OMB Paying and locating participants Final.docx	Supporting Statement A	Uploaded 2010-08-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Certification of Pension Plan Disability Status
13603	Locating and Paying Participants	Form and Instruction	Modified	Uniformed Services Information Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Certification of Social Security Disability Status
13603	Locating and Paying Participants	Form and Instruction	Modified	Request for Earnings Information
13603	Locating and Paying Participants	Other-Notice	Modified
13603	Locating and Paying Participants	Form and Instruction	Modified	Financial Statement of Debtor
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lump-Sum Payment -- Non-spouse Beneficiary or Estate
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lum-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Election to Withhold Federal Income Tax from Periodic Payments
13603	Locating and Paying Participants	Form and Instruction	Modified	Installment Payment Agreement
13603	Locating and Paying Participants	Form and Instruction	Modified	Monthly Payment Election Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Power of Attorney (POA)
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Payment of Employee Contributions -- Non-Spouse Beneficiary
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Payment of Employee Contributions
13603	Locating and Paying Participants	Form and Instruction	Modified	Change of Beneficiary for Certain & Continuous (C&C) Benefits Only
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Electronic Direct Deposit
13603	Locating and Paying Participants	Form and Instruction	Modified	Plan Participation Information
13603	Locating and Paying Participants	Form and Instruction	Modified	Designation of Beneficiary
13603	Locating and Paying Participants	Form and Instruction	Modified	Designation of Beneficiary for Benefits Owed at Death
13603	Locating and Paying Participants	Form and Instruction	Modified	Beneficiary Application for Pension Benefits -- OF
13603	Locating and Paying Participants	Form and Instruction	Modified	Beneficiary Application for Pension Benefits
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Elective Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Elective Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	General Information Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Payee Information Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Participant Application for Pension Benefits

ICR Details

OMB Control No: 1212-0055	ICR Reference No: 201008-1212-001
Status: Historical Active	Previous ICR Reference No: 200807-1212-006
Agency/Subagency: PBGC	Agency Tracking No:
Title: Locating and Paying Participants
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/05/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/09/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2013	09/30/2011	09/30/2011
Responses	84,800	0	89,100
Time Burden (Hours)	67,050	0	73,300
Cost Burden (Dollars)	3,730	0	3,100

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Abstract: This collection consists of information participants and beneficiaries are asked to provide in connection with an application for benefits or request for a benefit estimate. In addition, in some instances, as part of a search for participants and beneficiaries who may be entitled to benefits, the PBGC requests individuals to provide identifying information that the individual would provide as part of an initial contact with the PBGC.

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Authorizing Statute(s): PL: Pub.L. 109 - 280 410 Name of Law: Pension Protection Act of 2006
   US Code: 29 USC 1322, 1350 Name of Law: Employee Retirement Security Act (ERISA)
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 280 410 Name of Law: Pension Protection Act of 2006

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 30865	06/02/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 47857	08/09/2010
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Locating and Paying Participants	714, 703MP, 719, 710, 711, 706, 721, 700, 701, 708, 717, 705, 718, 722, 703, 702, 715, 713, 720MP, 720, 709, 707, 720CD, Form 716A, Form 712, Form 716, Form 704	Participant Application for Pension Benefits ,   Payee Information Form ,   General Information Form ,   Application for Elective Lump-Sum Payment ,   Application for Elective Lump-Sum Payment ,   Beneficiary Application for Pension Benefits ,   Beneficiary Application for Pension Benefits -- OF ,   Designation of Beneficiary for Benefits Owed at Death ,   Designation of Beneficiary ,   Plan Participation Information ,   Application for Electronic Direct Deposit ,   Change of Beneficiary for Certain & Continuous (C&C) Benefits Only ,   Application for Payment of Employee Contributions ,   Application for Payment of Employee Contributions -- Non-Spouse Beneficiary ,   Power of Attorney (POA) ,   Monthly Payment Election Form ,   Installment Payment Agreement ,   Election to Withhold Federal Income Tax from Periodic Payments ,   Application for Lump-Sum Payment ,   Application for Lump-Sum Payment ,   Application for Lum-Sum Payment ,   Application for Lump-Sum Payment -- Non-spouse Beneficiary or Estate ,   Financial Statement of Debtor ,   Request for Earnings Information ,   Certification of Social Security Disability Status ,   Uniformed Services Information Form ,   Certification of Pension Plan Disability Status

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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	84,800	89,100	0	0	-4,300	0
Annual Time Burden (Hours)	67,050	73,300	0	0	-6,250	0
Annual Cost Burden (Dollars)	3,730	3,100	0	0	630	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:

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Annual Cost to Federal Government: $6,863,600

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

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Common Form ICR:  No

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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: 08/09/2010

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