Annual Information Return/Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form 5500 Annual Information Return/Report	Form	Modified	Available
Justification for nonmaterial nonsubstantive changePBGC3-2012.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2012-03-14	Available
Justification for nonmaterial nonsubstantive change5-2011.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2011-05-06	Available
IRS Notice 2011-3.pdf	Supplementary Document	Uploaded 2010-12-29	Available
IRS Notice 2010-83.pdf	Supplementary Document	Uploaded 2010-12-09	Available
PBGC_2011F5500ssAmended clfin.122010.docx	Supporting Statement A	Uploaded 2010-12-20	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13607	Annual Information Return/Report	Form	Modified

ICR Details

OMB Control No: 1212-0057	ICR Reference No: 201203-1212-001
Status: Historical Active	Previous ICR Reference No: 201105-1212-001
Agency/Subagency: PBGC	Agency Tracking No:
Title: Annual Information Return/Report
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/27/2012
	Date Received in OIRA: 03/26/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	04/30/2014	04/30/2014
Responses	30,300	0	30,300
Time Burden (Hours)	1,200	0	1,200
Cost Burden (Dollars)	1,210,000	0	1,210,000

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Abstract: Sections 104 and 4065 of ERISA require plan administrators to file an annual report. The report must contain the information described in section 103 of ERISA. The Form 5500 Series provides a standard format for fulfilling that requirement.

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Authorizing Statute(s): US Code: 29 USC 1302(b)(3), 1365 Name of Law: ERISA
  

Citations for New Statutory Requirements: Statute at Large: 120 Stat. 780 Name of Statute: Pension Protection Act of 2006

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB06	Final or interim final rulemaking	71 FR 41392	07/21/2006

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 36127	06/24/2010
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
Annual Information Return/Report	Schedule I (Form 5500), Schedule MB (Form 5500), Form 5500-SF, Form 5500, Schedule A (Form 5500), Schedule C (Form 5500), Schedule D (Form 5500), Schedule G (Form 5500), Schedule H (Form 5500), Schedule R (Form 5500), Schedule SB (Form 5500), Form 5500, Schedule A (Form 5500), Form 5500-SF, Schedule C (Form 5500) , Schedule D (Form 5500) , Schedule G (Form 5500), Schedule H (Form 5500), Schedule I (Form 5500), Schedule MB (Form 5500), Schedule R (Form 5500), Schedule SB (Form 5500)	2012 Annual Return/Report of Employee Benefit Plan ,   2012 Short Form Annual Return/Report of Small Employee Benefit Plan ,   2012 Schedule A (Form 5500) - Insurance Information ,   2012 Schedule C (Form 5500) - Service Provider Information ,   2012 Schedule D (Form 5500) - DFE/Participating Plan Information ,   2012 Schedule G (Form 5500) - Financial Transaction Schedules ,   2012 Schedule H ( Form 5500) - Financial Information ,   2012 Schedule I (Form 5500) - Financial Information - Small Plan ,   2012 Schedule MB (Form 5500) - Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information ,   2012 Schedule R (Form 5500) - Retirement Plan Information ,   2012 Schedule B (Form 5500) - Single-Employer Defined Benefit Plan Actuarial Information ,   2012 Form 5500 Annual Return/Report of Employee Benefit Plan (Redline) ,   2012 Form 5500-SF Short Form Annual Return/Report of Employee Benefit Plan (Redline) ,   2012 Schedule A (Form 5500) - Insurance Information (Redline) ,   2012 Schedule C (Form 5500) - Service Provider Information (Redline) ,   2012 Schedule D (Form 5500) - DFE/Participating Plan Information (Redline) ,   2012 Schedule G (Form 5500) - Financial Transaction Schedules (Redline) ,   2012 Schedule H (Form 5500) - Financial Information (Redline) ,   2012 Schedule I (Form 5500) - Financial Information - Small Plan (Redline) ,   2012 Schedule MB (Form 5500) - Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information (Redline) ,   2012 Schedule R (Form 5500) - Retirement Plan Information (Redline) ,   2012 Schedule SB (Form 5500) - Single-Employer Defined Benefit Plan Actuarial Information (Redline)

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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	30,300	30,300	0	0	0	0
Annual Time Burden (Hours)	1,200	1,200	0	0	0	0
Annual Cost Burden (Dollars)	1,210,000	1,210,000	0	0	0	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: $671,000

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: 03/26/2012

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