Notice of Failure to Make Required Contributions

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	111	0	111
Annual IC Time Burden (Hours)	666	333	333
Annual IC Cost Burden (Dollars)	102,146	0	102,146

Documents for IC

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.