Locating and Paying Participants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form 722 Financial Statement of Debtor	Form and Instruction	Modified	Available
Form Form 721T Tax Election for Single Payment Not Eligible for Rollover	Form and Instruction	Modified	Available
Form Form 721 Application for Payment Eligible for Rollover – Non-Spouse Beneficiary	Form and Instruction	Modified	Available
Form Form 720MP Application for Lump-Sum Payment - Missing Participant	Form and Instruction	Modified	Available
Form Form 720CD Application for Lump-Sum Payment	Form and Instruction	Modified	Available
Form Form 720 Application for Lump-Sum Payment	Form and Instruction	Modified	Available
Form Form 719 Election to Withhold Federal Income Tax from Periodic Payments	Form and Instruction	Modified	Available
Form Form 718 Installment Payment Agreement	Form and Instruction	Modified	Available
Form Form 716A Certification of Pension Plan Disability Status	Form and Instruction	Modified	Available
Form Form 716 Certification of Social Security Disability Status	Form and Instruction	Modified	Available
Form Form 715 Power of Attorney (POA)	Form and Instruction	Modified	Available
Form Form 714 Withdrawal of Employee Contributions – Non-Spouse Beneficiary	Form and Instruction	Modified	Available
Form Form 712 Uniformed Services Information Form	Form and Instruction	Modified	Available
Form Form 711 Change of Beneficiary for Certain & Continuous (C&C) Benefits Only	Form and Instruction	Modified	Available
Form Form 710 Application for Electronic Direct Deposit	Form and Instruction	Modified	Available
Form Form 709 Plan Participation Information	Form and Instruction	Modified	Available
Form Form 708 Designation of Beneficiary	Form and Instruction	Modified	Available
Form Form 707 Designation of Beneficiary for Benefits Owed at Death	Form and Instruction	Modified	Available
Form Form 706 Beneficiary Application for Pension Benefits - OF	Form and Instruction	Modified	Available
Form Form 705 Beneficiary Application for Pension Benefits	Form and Instruction	Modified	Available
Form Form 704 Report for Earnings and Social Security Disability Information	Form and Instruction	Modified	Available
Form Form 703MP Application for Elective Lump-Sum Payment - Missing Participant	Form and Instruction	Modified	Available
Form Form 703 Application for Elective Lump-Sum Payment	Form and Instruction	Modified	Available
Form Form 702 General Information Form	Form and Instruction	Modified	Available
Form Form 701 Payee Information Form	Form and Instruction	Modified	Available
Form Form 700 Participant Application for Pension Benefits	Form and Instruction	Modified	Available
Form Form 713 Election to Withdraw Employee Contributions	Form and Instruction	Modified	Available
Supporting statement 2OMB Paying and locating participants Final 2012.docx	Supporting Statement A	Uploaded 2012-09-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13603	Locating and Paying Participants	Other-Privacy Notices	Modified
13603	Locating and Paying Participants	Form and Instruction	Modified	Financial Statement of Debtor
13603	Locating and Paying Participants	Form and Instruction	Modified	Tax Election for Single Payment Not Eligible for Rollover
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Payment Eligible for Rollover – Non-Spouse Beneficiary
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lump-Sum Payment - Missing Participant
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Election to Withhold Federal Income Tax from Periodic Payments
13603	Locating and Paying Participants	Form and Instruction	Modified	Installment Payment Agreement
13603	Locating and Paying Participants	Form and Instruction	Modified	Certification of Pension Plan Disability Status
13603	Locating and Paying Participants	Form and Instruction	Modified	Certification of Social Security Disability Status
13603	Locating and Paying Participants	Form and Instruction	Modified	Power of Attorney (POA)
13603	Locating and Paying Participants	Form and Instruction	Modified	Withdrawal of Employee Contributions – Non-Spouse Beneficiary
13603	Locating and Paying Participants	Form and Instruction	Modified	Uniformed Services Information Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Change of Beneficiary for Certain & Continuous (C&C) Benefits Only
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Electronic Direct Deposit
13603	Locating and Paying Participants	Form and Instruction	Modified	Plan Participation Information
13603	Locating and Paying Participants	Form and Instruction	Modified	Designation of Beneficiary
13603	Locating and Paying Participants	Form and Instruction	Modified	Designation of Beneficiary for Benefits Owed at Death
13603	Locating and Paying Participants	Form and Instruction	Modified	Beneficiary Application for Pension Benefits - OF
13603	Locating and Paying Participants	Form and Instruction	Modified	Beneficiary Application for Pension Benefits
13603	Locating and Paying Participants	Form and Instruction	Modified	Report for Earnings and Social Security Disability Information
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Elective Lump-Sum Payment - Missing Participant
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Elective Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	General Information Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Payee Information Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Participant Application for Pension Benefits
13603	Locating and Paying Participants	Form and Instruction	Modified	Election to Withdraw Employee Contributions

ICR Details

OMB Control No: 1212-0055	ICR Reference No: 201209-1212-003
Status: Historical Active	Previous ICR Reference No: 201008-1212-001
Agency/Subagency: PBGC	Agency Tracking No:
Title: Locating and Paying Participants
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/21/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/28/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2015	36 Months From Approved	12/31/2013
Responses	102,050	0	84,800
Time Burden (Hours)	87,500	0	67,050
Cost Burden (Dollars)	2,270	0	3,730

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Abstract: This collection consists of information participants and beneficiaries are asked to provide in connection with an application for benefits or request for a benefit estimate. In addition, in some instances, as part of a search for participants and beneficiaries who may be entitled to benefits, the PBGC requests individuals to provide identifying information that the individual would provide as part of an initial contact with the PBGC.

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Authorizing Statute(s): PL: Pub.L. 109 - 280 410 Name of Law: Pension Protection Act of 2006
   US Code: 29 USC 1322, 1350 Name of Law: Employee Retirement Security Act (ERISA)
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 280 410 Name of Law: Pension Protection Act of 2006

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 25505	04/30/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 59682	09/28/2012
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
Locating and Paying Participants	Form 720CD, Form 720MP, Form 721, Form 721T, Form 722, Form 700, Form 703MP, Form 704, Form 705, Form 702, Form 701, Form 708, Form 703, Form 706, Form 707, Form 709, Form 710, Form 711, Form 712, Form 713, Form 714, Form 715, Form 716, Form 716A, Form 720, Form 718, Form 719	Participant Application for Pension Benefits ,   Payee Information Form ,   General Information Form ,   Application for Elective Lump-Sum Payment ,   Application for Elective Lump-Sum Payment - Missing Participant ,   Report for Earnings and Social Security Disability Information ,   Beneficiary Application for Pension Benefits ,   Beneficiary Application for Pension Benefits - OF ,   Designation of Beneficiary for Benefits Owed at Death ,   Designation of Beneficiary ,   Plan Participation Information ,   Application for Electronic Direct Deposit ,   Change of Beneficiary for Certain & Continuous (C&C) Benefits Only ,   Uniformed Services Information Form ,   Election to Withdraw Employee Contributions ,   Withdrawal of Employee Contributions – Non-Spouse Beneficiary ,   Power of Attorney (POA) ,   Certification of Social Security Disability Status ,   Certification of Pension Plan Disability Status ,   Installment Payment Agreement ,   Election to Withhold Federal Income Tax from Periodic Payments ,   Application for Lump-Sum Payment ,   Application for Lump-Sum Payment ,   Application for Lump-Sum Payment - Missing Participant ,   Application for Payment Eligible for Rollover – Non-Spouse Beneficiary ,   Tax Election for Single Payment Not Eligible for Rollover ,   Financial Statement of Debtor

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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	102,050	84,800	0	0	17,250	0
Annual Time Burden (Hours)	87,500	67,050	0	0	20,450	0
Annual Cost Burden (Dollars)	2,270	3,730	0	0	-1,460	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: $3,269,900

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: 09/28/2012

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