Annual Information Return/Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
211856	CSEC Multiple Employer Plan Revision		New
205399	Multiple Employer Welfare Arrangements Revisions of Form 5500		Unchanged
13467	Annual Information Return/Report		Unchanged

ICR Details

OMB Control No: 1210-0110	ICR Reference No: 201406-1210-005
Status: Historical Inactive	Previous ICR Reference No: 201403-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Annual Information Return/Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 10/07/2014
OIRA Conclusion Action: Preapproved	Conclusion Date: 10/07/2014
	Date Received in OIRA: 09/08/2014
Terms of Clearance: Approved without change.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2015	6 Months From Approved	05/31/2016
Responses	791,575	0	786,048
Time Burden (Hours)	557,765	0	555,001
Cost Burden (Dollars)	218,939,600	0	218,939,600

---

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

Emergency Justfication: President Obama signed the “Cooperative and Small Employer Charity Pension Flexibility Act (the CSEC Act),” on April 7, 2014. Section 104(c) of the CSEC Act amends section 103 of the Employee Retirement Income Security Act by adding a new subparagraph (g), which requires all multiple employer plans to submit with their Form 5500 Annual Report (1) a list of contributing employers and (2) a good faith estimate of the percentage of total contributions made by such participating employers during the plan year. The Form 5500 Annual Report is a collection of information subject to the Paperwork Reduction Act (OMB Control #1210-0110), which currently is scheduled to expire on May 31, 2016. The Department received clearance from OMB for the 2014 Form 5500 on March 27, 2014 (ICR Reference Number 201403-1210-001). The Department seeks approval of revisions to Form 5500 to reflect the changes enacted in CSEC Act. The multiple employer reporting requirements under the CSEC Act apply to plan years beginning after December 31, 2013, thus creating an immediate need for changes to the Form 5500. Without these changes, filers would have no uniform way to comply with the new requirements under the CSEC Act. The use of normal Paperwork Reduction Act clearance procedures would likely disrupt or prevent the statutorily mandated collection of information in time for plan year 2014 filings. Therefore, in accordance with 5 CFR 1320.13, the Department is hereby requesting emergency clearance from OMB to issue the revised Form 5500 and Form 5500-SF within thirty (30) days after the Department submits the revised information collection request for the Form 5500 to OMB.

---

Authorizing Statute(s): US Code: 29 USC 1023 Name of Law: Employee Retirement Income Security Act of 1974
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 280 1103(b) Name of Law: Pension Protection Act of 2006
PL: Pub.L. 113 - 97 104(c) Name of Law: The Cooperative and Small Employer Charity Pension Flexibility Act

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB66	Final or interim final rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Annual Information Return/Report	Form 5500 Schedule MB, Form 5500 Schedule SB, Form 5500 Schedule D, Form 5500 Schedule G, Form 5500 Schedule H, Form 5500-SF, Form 5500 Schedule R, Form 5500, Form 5500 Schedule A, Form 5500 Schedule C, Form 5500 Schedule I
CSEC Multiple Employer Plan Revision	5500-SF, 5500
Multiple Employer Welfare Arrangements Revisions of Form 5500	Form 5500

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	791,575	786,048	552	4,975	0	0
Annual Time Burden (Hours)	557,765	555,001	2,763	1	0	0
Annual Cost Burden (Dollars)	218,939,600	218,939,600	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Department is revising the ICR to reflect the hour burden associated with the CSEC Act amendments.

---

Annual Cost to Federal Government: $6,900,000

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

---

Common Form ICR:  No

---

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: 09/08/2014

---