Disclosure of Termination Information

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Disclosure_of_Distress_Termination_Information.docx		Yes	No	Printable Only
Instruction			Disclosure of PBGC-initiated Termination Information.docx		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 %

	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

Title	Document	Date Uploaded
Supporting Statement	Supporting Statement 2011 Final.docx	06/28/2011

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