Form T and instructions

Termination Premium

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0064 can be found here:

Documents and Forms

Document Name Document Type
Form T Form T and instructions Form and Instruction
T Termination Premium Declaration Form T package 2017.d2.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Form T and instructions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4000, 4007 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	T	Termination Premium Declaration	Form T package 2017.d2.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: 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	3	-57	60
Annual IC Time Burden (Hours)	0	-10	10
Annual IC Cost Burden (Dollars)	200	-8,600	8,800

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.