Information Collection

Annual Information Return/Report

IC 13607 under ICR 201412-1212-001 · OMB 1212-0057.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0057 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2015 Schedule A (F Annual Information Return/Report	Form
PBGC Proposed Changes to the 2015 Form 5500 SB Instructions to OMB 3_15.pdf	Instruction
PBGC Proposed Changes to the 2015 Form 5500 MB Instructions to OMB 3_15.pdf	Instruction
2015 Form 5500 Instructions - 150320 Clean Draft.pdf	Instruction
2015 Form 5500 Instructions - 150320 RLSO Draft.pdf	Instruction
2015 Form 5500 SF Instructions - 150320 Clean Draft.pdf	Instruction
2015 Form 5500 SF Instructions - 150320 RLSO Draft.pdf	Instruction
2015 Schedule MB ( 2015 Schedule MB (Form 5500) - Multiemployer Defined Ben Proposed Changes to the 2015 Form 5500 MB to OMB 3_2015.pdf	Form
2015 Form 5500 2015 Annual Return/Report of Employee Benefit Plan 150123 Clean Form5500.pdf	Form
2015 Form 5500-SF 2015 Short Form Annual Return/Report of Small Employee B 150123 Clean Form5500SF.pdf	Form
2015 Form 5500 2015 Annual Return/Report of Employee Benefit Plan (RLSO 150123 RLSO Form5500.pdf	Form
2015 Form 5500-SF 2015 Short Form Annual Return/Report of Small Employee B 150123 RLSO Form5500SF.pdf	Form
2015 Schedule A (F 2015 Schedule A (Form 5500) - Insurance Information 150123 Clean SchA.pdf	Form
2015 Schedule A (F 2015 Schedule A (Form 5500) - Insurance Information (RLS 150123 RLSO SchA.pdf	Form
2015 Schedule C (F 2015 Schedule C (Form 5500) - Service Provider Informati 150123 Clean SchC.pdf	Form
2015 Schedule C (F 2015 Schedule C (Form 5500) Service Provider Information 150123 RLSO SchC.pdf	Form
2015 Schedule D (F 2015 Schedule D (Form 5500) - DFE/Participating Provider 150123 Clean SchD.pdf	Form
2015 Schedule D (F 2015 Schedule D (Form 5500) - DFE/Participating Provider 150123 RLSO SchD.pdf	Form
2015 Schedule G (F 2015 Schedule G (Form 5500) - Financial Transation Sched 150123 Clean SchG.pdf	Form
2015 Schedule G (F 2015 Schedule G (Form 5500) - Financial Transaction Sche 150123 RLSO SchG.pdf	Form
2015 Schedule H (F 2015 Schedule H (Form 5500) - Financial Information 150123 Clean SchH.pdf	Form
2015 Schedule H (F 2015 Schedule H (Form 5500) - Financial Information (RLS 150123 RLSO SchH.pdf	Form
2015 Schedule I (F 2015 Schedule I (Form 5500) - Financial Information - Sm 150123 Clean SchI.pdf	Form
2015 Schedule I (F 2015 Schedule I (Form 5500) - Financial Information - Sm 150123 RLSO SchI.pdf	Form
2015 Schedule MB ( 2015 Schedule MB (Form 5500) - Multiemployer Defined Ben 150128 Clean SchMB.pdf	Form
2015 Schedule MB ( 2015 Schedule MB (Form 5500) - Multiemployer Defined Ben 150128 RLSO SchMB.pdf	Form
2015 Schedule R (F 2015 Schedule R (Form 5500) - Retirement Plan Informatio 150123 Clean SchR.pdf	Form
2015 Schedule R (F 2015 Schedule R (Form 5500) - Retirement Plan Informatio 150123 RLSO SchR.pdf	Form
2015 Schedule SB ( 2015 Schedule SB (Form 5500) - Single-Employer Defined B 150123 Clean SchSB.pdf	Form
2015 Schedule SB ( 2015 Schedule SB (Form 5500) - Single-Employer Defined B 150123 RLSO SchSB.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Annual Information Return/Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4065

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
Form	2015 Schedule A (Form 5500)	2015 Schedule A (Form 5500) - Insurance Information (RLSO)	150123 RLSO SchA.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule C (Form 5500)	2015 Schedule C (Form 5500) - Service Provider Information	150123 Clean SchC.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule C (Form 5500)	2015 Schedule C (Form 5500) Service Provider Information (RLSO)	150123 RLSO SchC.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule D (Form 5500)	2015 Schedule D (Form 5500) - DFE/Participating Provider Information	150123 Clean SchD.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule G (Form 5500)	2015 Schedule G (Form 5500) - Financial Transaction Schedules (RLSO)	150123 RLSO SchG.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule H (Form 5500)	2015 Schedule H (Form 5500) - Financial Information	150123 Clean SchH.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule I (Form 5500)	2015 Schedule I (Form 5500) - Financial Information - Small Plan	150123 Clean SchI.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule R (Form 5500)	2015 Schedule R (Form 5500) - Retirement Plan Information	150123 Clean SchR.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule SB (Form 5500)	2015 Schedule SB (Form 5500) - Single-Employer Defined Benefit Plan Actuarial Information	150123 Clean SchSB.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule SB (Form 5500)	2015 Schedule SB (Form 5500) - Single-Employer Defined Benefit Plan Actuarial Information (RLSO)	150123 RLSO SchSB.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			2015 Form 5500 SF Instructions - 150320 RLSO Draft.pdf	Yes	Yes	Fillable Fileable
Form	2015 Form 5500	2015 Annual Return/Report of Employee Benefit Plan	150123 Clean Form5500.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Form 5500	2015 Annual Return/Report of Employee Benefit Plan (RLSO)	150123 RLSO Form5500.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule A (Form 5500)	2015 Schedule A (Form 5500) - Insurance Information	150123 Clean SchA.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule MB (Form 5500) PBGC Revisions	2015 Schedule MB (Form 5500) - Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information (RLSO) - PBGC Revisions	Proposed Changes to the 2015 Form 5500 MB to OMB 3_2015.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			PBGC Proposed Changes to the 2015 Form 5500 SB Instructions to OMB 3_15.pdf	Yes	Yes	Fillable Fileable
Instruction			PBGC Proposed Changes to the 2015 Form 5500 MB Instructions to OMB 3_15.pdf	Yes	Yes	Fillable Fileable
Instruction			2015 Form 5500 Instructions - 150320 Clean Draft.pdf	Yes	Yes	Fillable Fileable
Instruction			2015 Form 5500 Instructions - 150320 RLSO Draft.pdf	Yes	Yes	Fillable Fileable
Instruction			2015 Form 5500 SF Instructions - 150320 Clean Draft.pdf	Yes	Yes	Fillable Fileable
Form	2015 Form 5500-SF	2015 Short Form Annual Return/Report of Small Employee Benefit Plan	150123 Clean Form5500SF.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Form 5500-SF	2015 Short Form Annual Return/Report of Small Employee Benefit Plan (RLSO)	150123 RLSO Form5500SF.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule D (Form 5500)	2015 Schedule D (Form 5500) - DFE/Participating Provider Information (RLSO)	150123 RLSO SchD.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule G (Form 5500)	2015 Schedule G (Form 5500) - Financial Transation Schedules	150123 Clean SchG.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule H (Form 5500)	2015 Schedule H (Form 5500) - Financial Information (RLSO)	150123 RLSO SchH.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule I (Form 5500)	2015 Schedule I (Form 5500) - Financial Information - Small Plan (RLSO)	150123 RLSO SchI.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule MB (Form 5500)	2015 Schedule MB (Form 5500) - Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information	150128 Clean SchMB.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule MB (Form 5500)	2015 Schedule MB (Form 5500) - Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information (RLSO)	150128 RLSO SchMB.pdf	Yes	Yes	Fillable Fileable Signable
Form	2015 Schedule R (Form 5500)	2015 Schedule R (Form 5500) - Retirement Plan Information (RLSO)	150123 RLSO SchR.pdf	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24,000

Number of Respondents for Small Entity: 17,500

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 1 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	24,000	-1,000	25,000
Annual IC Time Burden (Hours)	1,200	0	1,200
Annual IC Cost Burden (Dollars)	1,407,000	50,000	1,357,000

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.