Annual Information Return/Report

ICR 201703-1212-002

OMB: 1212-0057

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2017-03-29
Supporting Statement A
2016-10-07
IC Document Collections
IC ID
Document
Title
Status
13607 Modified
ICR Details
1212-0057 201703-1212-002
Historical Active 201607-1212-001
PBGC
Annual Information Return/Report
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 04/17/2017
Retrieve Notice of Action (NOA) 03/29/2017
  Inventory as of this Action Requested Previously Approved
06/30/2017 06/30/2017 06/30/2017
23,700 0 24,000
1,185 0 1,200
1,655,000 0 1,465,000

Sections 104 and 4065 of ERISA require plan administrators to file an annual report. The report must contain the information described in section 103 of ERISA. The Form 5500 Series provides a standard format for fulfilling that requirement.

US Code: 29 USC 1302(b)(3), 1365 Name of Law: ERISA
  
Statute at Large: 120 Stat. 780 Name of Statute: Pension Protection Act of 2006

Not associated with rulemaking

  79 FR 62681 10/20/2014
80 FR 11501 03/03/2015
No

1
IC Title Form No. Form Name
Annual Information Return/Report 2017 Schedule SB (Form 5500), 2017 Schedule D (Form 5500), 2017 Schedule A (Form 5500), 2017 Schedule H (Form 5500), 2017 Schedule I (Form 5500), 2017 Form 5500, 2017 Schedule MB (Form 5500) , 2017 Form 5500, 2017 Form 5500-SF, 2017 Schedule R (Form 5500), 2017 Schedule G (Form 5500), 2017 Schedule H (Form 5500), 2017 Schedule C (Form 5500), 2017 Schedule C (Form 5500), 2017 Schedule G (Form 5500), 2017 Schedule MB (Form 5500), 2017 Schedule SB (Form 5500), 2017 Form 5500-SF, 2017 Schedule A (Form 5500), 2017 Schedule D (Form 5500), 2017 Schedule I (Form 5500), 2017 Schedule R (Form 5500) 2017 Annual Return/Report of Employee Benefit Plan (Clean) ,   2017 Short Form Annual Return/Report of Small Employee Benefit Plan (Clean) ,   2017 Schedule A (Form 5500) - Insurance Information (Clean) ,   2017 Schedule C (Form 5500) - Service Provider Information (Clean) ,   2017 Schedule D (Form 5500) - DFE/Participating Plan Information (Clean) ,   2017 Schedule G (Form 5500) - Financial Transaction Schedules (Clean) ,   2017 Schedule H (Form 5500) - Financial Information (Clean) ,   2017 Schedule I (Form 5500) - Financial Information - Small Plan (Clean) ,   2017 Schedule MB (Form 5500) - Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information (Clean) ,   2017 Schedule R (Form 55) - Retirement Plan Information (Clean) ,   2017 Schedule SB (Form 5500) - Single-Employer Defined Benefit Plan Actuarial Information (Clean) ,   2017 Annual Return/Report of Employee Benefit Plan (RLSO) ,   2017 Short Form Annual Return/Report of Small Employee Benefit Plan (RLSO) ,   2017 Schedule A (Form 5500) - Insurance Information (RLSO) ,   2017 Schedule C (Form 5500) - Service Provider Information (RLSO) ,   2017 Schedule D (Form 5500) - DFE/Participating Plan Information (RLSO) ,   2017 Schedule G (Form 5500) - Financial Transaction Schedules (RLSO) ,   2017 Schedule H (Form 5500) - Financial Information (RLSO) ,   2017 Schedule I (Form 5500) - Financial Information - Small Plan (RLSO) ,   2017 Schedule MB (Form 5500) - Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information (RLSO) ,   2017 Schedule R (Form 55) - Retirement Plan Information (RLSO) ,   2017 Schedule SB (Form 5500) - Single-Employer Defined Benefit Plan Actuarial Information (RLSO)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 23,700 24,000 0 0 -300 0
Annual Time Burden (Hours) 1,185 1,200 0 0 -15 0
Annual Cost Burden (Dollars) 1,655,000 1,465,000 0 0 190,000 0
No
No

$822,000
No
No
No
No
No
Uncollected
Jo Amato Burns 202-326-4223 ext. 3072 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/29/2017


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