Information Collection

Disclosure of Termination Information

IC 182656 under ICR 201408-1212-001 · OMB 1212-0065.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0065 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Disclosure of Distress Termination Information.docx	Instruction
Disclosure of PBGC-initiated Termination Information.docx	Instruction
Supporting Statement 2014 Final.docx Supporting Statement 2014	IC Document

IC Title:

Disclosure of Termination Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1342 29 CFR 1341

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
Instruction			Disclosure of PBGC-initiated Termination Information.docx		No		Paper Only
Instruction			Disclosure of Distress Termination Information.docx		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2	-1	3
Annual IC Time Burden (Hours)	30	-15	45
Annual IC Cost Burden (Dollars)	600	-300	900

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement 2014	Supporting Statement 2014 Final.docx	08/28/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.