Information Collection

Notice of Failure to Make Required Contributions

IC 13574 under ICR 201302-1212-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Notice of Failure to Make Required Contributions	Form
Form 200 Instructions_ Proposed Rule.2OMB.2013rule.pdf www.pbgc.gov/Documents/200_instructions.pdf	Instruction
200 Notice of Failure to Make Required Contributions Form 200_2013 Proposed Rule 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
Form	200	Notice of Failure to Make Required Contributions	Form 200_2013 Proposed Rule to OMB.pdf	http://www.pbgc.gov/Documents/200.pdf	Yes	Yes	Fillable Printable
Instruction			Form 200 Instructions_ Proposed Rule.2OMB.2013rule.pdf	http://www.pbgc.gov/Documents/200_instructions.pdf	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 63

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: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	136	25	111
Annual IC Time Burden (Hours)	816	150	666
Annual IC Cost Burden (Dollars)	125,000	22,854	102,146

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.