Annual Information Return/Report of Employee Benefit Plan

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 5500 CSEC Multiple Employer Plan Revision	Form	Removed	Available
Form 5500 EBSA Supporting Statement 7-6-16.docx	Supporting Statement A	Uploaded 2016-07-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
211856	CSEC Multiple Employer Plan Revision	Form	Removed
205399	Multiple Employer Welfare Arrangements Revisions of Form 5500		Removed
13467	Annual Information Return/Report of Employee Benefit Plan		Modified

ICR Details

OMB Control No: 1210-0110	ICR Reference No: 201604-1210-001
Status: Historical Inactive	Previous ICR Reference No: 201504-1210-003
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Annual Information Return/Report of Employee Benefit Plan
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 10/12/2016
	Date Received in OIRA: 07/21/2016
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2018	36 Months From Approved	08/31/2018
Responses	827,575	0	827,575
Time Burden (Hours)	581,765	0	581,765
Cost Burden (Dollars)	229,389,600	0	229,389,600

---

Abstract: Section 104 and 4065 of ERISA require plan administrators to file an annual report containing the information described in section 103 of ERISA. The Form 5500 provides a standard format for fulfilling that requirement.

---

Authorizing Statute(s): US Code: 29 USC 1023 Name of Law: Employee Retirement Income Security Act of 1974
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB63	Proposed rulemaking	81 FR 47496	07/21/2016

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 47534	07/21/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 47496	07/21/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
CSEC Multiple Employer Plan Revision	5500-SF, 5500	Annual Return/Report Employee Benefit Plan (CSEC Revision) ,   Short Form Annual Return/Report of Small Employee Benefit Plan (CSEC Revision)
Annual Information Return/Report of Employee Benefit Plan
Multiple Employer Welfare Arrangements Revisions of Form 5500

---

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: The change in burden reflects the NPRM's revisions to the Form 5500 with respect to who is required to report and what must be reported.

---

Annual Cost to Federal Government: $6,800,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/21/2016

---