Information Collection

Termination of Single Employer Plans

IC 13567 under ICR 201409-1212-001 · OMB 1212-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Standard termination instructions 2014 Final.docx	Instruction
Distress Termination instructions 2014 Final.docx	Instruction
MP_instructions 2014 Final.docx	Instruction
Forms 500 to 501 Standard termination forms Standard termination forms 2014 Final.docx	Form
Forms 600 to 602 Distress termination forms Distress Termination forms 2014 Final.docx	Form
Schedule MP (missi Schedule MP Schedule MP forms 2014 Final.docx	Form
Supporting Statement 2014 Final.docx Supporting Statement	IC Document

IC Title:

Termination of Single Employer Plans

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4050 29 CFR 4041

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Standard termination instructions 2014 Final.docx	Yes	No	Printable Only
Form	Forms 500 to 501	Standard termination forms	Standard termination forms 2014 Final.docx	Yes	No	Fillable Printable
Instruction			Distress Termination instructions 2014 Final.docx	Yes	No	Printable Only
Form	Forms 600 to 602	Distress termination forms	Distress Termination forms 2014 Final.docx	Yes	No	Printable Only
Instruction			MP_instructions 2014 Final.docx	Yes	No	Printable Only
Form	Schedule MP (missing participant)	Schedule MP	Schedule MP forms 2014 Final.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: 1,430

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,430	0	0	1,430
Annual IC Time Burden (Hours)	1,708	41	0	1,667
Annual IC Cost Burden (Dollars)	1,721,391	41,300	-1,081,110	2,761,201

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Supporting Statement 2014 Final.docx	10/20/2014

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