Information Collection

Notice of Failure to Make Required Contributions

IC 13574 under ICR 201202-1212-003 · OMB 1212-0041.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0041 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 200 Instr._2012 ROLLOVER_to OMB.pdf	Instruction
200 Notice of Failure to Make Required Contributions Form 200_2012 ROLLOVER_to OMB.pdf www.pbgc.gov/Documents/200.pdf	Form

IC Title:

Notice of Failure to Make Required Contributions

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4043

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			Form 200 Instr._2012 ROLLOVER_to OMB.pdf		Yes	Yes	Printable Only
Form	200	Notice of Failure to Make Required Contributions	Form 200_2012 ROLLOVER_to OMB.pdf	http://www.pbgc.gov/Documents/200.pdf	Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 111

Number of Respondents for Small Entity: 8

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 55 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	111	-315	426
Annual IC Time Burden (Hours)	333	-540	873
Annual IC Cost Burden (Dollars)	102,146	-203,404	305,550

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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