Information Collection

Petition for Finding Under Section 3(40) of ERISA

IC 13496 under ICR 201605-1210-006 · OMB 1210-0119.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0119 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Petition for Finding Under Section 3(40) of ERISA	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 2570.159 29 CFR 2570.152 29 CFR 2570.153 29 CFR 2570.154 29 CFR 2570.150 29 CFR 2570.155 29 CFR 2570.156 29 CFR 2570.157 29 CFR 2570.158 29 CFR 2570.151

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10	0	10
Annual IC Time Burden (Hours)	50	0	50
Annual IC Cost Burden (Dollars)	41,000	2,546	38,454

Documents for IC

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