Information Collection

Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)

IC 13552 under ICR 201509-1212-006 · OMB 1212-0032.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0032 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 1 Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Form
Form 1 Notice of Insolvency Benefit Level insolvencybenefitlevelnotice 9162015.docx	Form
Form 2 Notice of Insolvency insolvencynotice 9162015.docx	Form
Form 3 Application for Financial Assistance Initial applicationforfinancialassistance 9162015.docx	Form
Form 4 Application for Financial Assistance Recurring applicationfinancialassistancerecurring 9162015.docx	Form

IC Title:

Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4281

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	Form 1	Notice of Insolvency Benefit Level	insolvencybenefitlevelnotice 9162015.docx	Yes	Yes	Fillable Fileable
Form	Form 2	Notice of Insolvency	insolvencynotice 9162015.docx	Yes	Yes	Fillable Fileable
Form	Form 3	Application for Financial Assistance Initial	applicationforfinancialassistance 9162015.docx	Yes	Yes	Fillable Fileable
Form	Form 4	Application for Financial Assistance Recurring	applicationfinancialassistancerecurring 9162015.docx	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

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	164,501	0	0	164,501
Annual IC Time Burden (Hours)	60	0	59	1
Annual IC Cost Burden (Dollars)	309,020	-98,133	0	407,153

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.