Reportable Events

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0013 can be found here:

Documents and Forms

Document Name Document Type
Form 10 Instr _2015 Rollover2OMB.doc Instruction
Form 10 ADV Instr _2015 ROLLOVER2OMB_REVISED_5.1.25.doc Instruction
Form 10 Post-Event Notice of Reportable Events Form 10 Revised2OMB.docx Form
Form 10-A Advance Notice of Reportable Events Form 10-A Revised_FINAL.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Reportable Events	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Form 10 Instr _2015 Rollover2OMB.doc	Yes	Yes	Fillable Fileable
Instruction			Form 10 ADV Instr _2015 ROLLOVER2OMB_REVISED_5.1.25.doc	Yes	Yes	Fillable Fileable
Form	Form 10-A	Advance Notice of Reportable Events	Form 10-A Revised_FINAL.docx	Yes	Yes	Fillable Fileable
Form	Form 10	Post-Event Notice of Reportable Events	Form 10 Revised2OMB.docx	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 868	Number of Respondents for Small Entity: 286

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 55 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	868	-158	1,026
Annual IC Time Burden (Hours)	4,500	-900	5,400
Annual IC Cost Burden (Dollars)	214,470	-607,356	821,826

Documents for IC

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.