Information Collection

Disclosure of Termination Information

IC 182656 under ICR 201106-1212-001 · OMB 1212-0065.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0065 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Disclosure_of_Distress_Termination_Information.docx	Instruction
Disclosure of PBGC-initiated Termination Information.docx	Instruction
Supporting Statement 2011 Final.docx Supporting Statement	IC Document

IC Title:

Disclosure of Termination Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1341 29 CFR 1342

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
Instruction					Yes	No	Printable Only
Instruction					No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3	-9,997	10,000
Annual IC Time Burden (Hours)	45	-29,955	30,000
Annual IC Cost Burden (Dollars)	900	-254,100	255,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement		06/28/2011

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

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