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Annual Information Return/Report
Annual Information Return/Report
OMB: 1212-0057
IC ID: 13607
OMB.report
PBGC
OMB 1212-0057
ICR 201707-1212-003
IC 13607
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0057 can be found here:
2024-04-03 - No material or nonsubstantive change to a currently approved collection
2023-02-27 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 2017 Form 5500
Annual Information Return/Report
Form
2017 Form 5500 Instructions CLEAN 032317.pdf
Instruction
2017 Form 5500SF Instruction CLEAN 032317.pdf
Instruction
2017 Form 5500 2017 Annual Return/Report of Employee Benefit Plan (Clea
170203 Clean Form 5500.pdf
Form
2017 Form 5500-SF 2017 Short Form Annual Return/Report of Small Employee B
170203 Clean Form 5500SF.pdf
Form
2017 Schedule A (F 2017 Schedule A (Form 5500) - Insurance Information (Cle
170203 Clean Sch A.pdf
Form
2017 Schedule C (F 2017 Schedule C (Form 5500) - Service Provider Informati
170203 Clean Sch C.pdf
Form
2017 Schedule D (F 2017 Schedule D (Form 5500) - DFE/Participating Plan Inf
170203 Clean Sch D.pdf
Form
2017 Schedule G (F 2017 Schedule G (Form 5500) - Financial Transaction Sche
170203 Clean Sch G.pdf
Form
2017 Schedule H (F 2017 Schedule H (Form 5500) - Financial Information (Cle
170203 Clean Sch H.pdf
Form
2017 Schedule I (F 2017 Schedule I (Form 5500) - Financial Information - Sm
170203 Clean Sch I.pdf
Form
2017 Schedule MB ( 2017 Schedule MB (Form 5500) - Multiemployer Defined Ben
170203 Clean Sch MB.pdf
Form
2017 Schedule R (F 2017 Schedule R (Form 55) - Retirement Plan Information
170203 Clean Sch MB.pdf
Form
2017 Schedule SB ( 2017 Schedule SB (Form 5500) - Single-Employer Defined B
170203 Clean Sch SB.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Annual Information Return/Report
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
29 CFR 4065
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
2017 Form 5500
2017 Annual Return/Report of Employee Benefit Plan (Clean)
170203 Clean Form 5500.pdf
Yes
Yes
Fillable Fileable Signable
Form
2017 Form 5500-SF
2017 Short Form Annual Return/Report of Small Employee Benefit Plan (Clean)
170203 Clean Form 5500SF.pdf
Yes
Yes
Fillable Fileable Signable
Form
2017 Schedule A (Form 5500)
2017 Schedule A (Form 5500) - Insurance Information (Clean)
170203 Clean Sch A.pdf
Yes
Yes
Fillable Fileable Signable
Form
2017 Schedule C (Form 5500)
2017 Schedule C (Form 5500) - Service Provider Information (Clean)
170203 Clean Sch C.pdf
Yes
Yes
Fillable Fileable Signable
Form
2017 Schedule D (Form 5500)
2017 Schedule D (Form 5500) - DFE/Participating Plan Information (Clean)
170203 Clean Sch D.pdf
Yes
Yes
Fillable Fileable Signable
Form
2017 Schedule G (Form 5500)
2017 Schedule G (Form 5500) - Financial Transaction Schedules (Clean)
170203 Clean Sch G.pdf
Yes
Yes
Fillable Fileable Signable
Form
2017 Schedule H (Form 5500)
2017 Schedule H (Form 5500) - Financial Information (Clean)
170203 Clean Sch H.pdf
Yes
Yes
Fillable Fileable Signable
Form
2017 Schedule I (Form 5500)
2017 Schedule I (Form 5500) - Financial Information - Small Plan (Clean)
170203 Clean Sch I.pdf
Yes
Yes
Fillable Fileable Signable
Form
2017 Schedule MB (Form 5500)
2017 Schedule MB (Form 5500) - Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information (Clean)
170203 Clean Sch MB.pdf
Yes
Yes
Fillable Fileable Signable
Form
2017 Schedule R (Form 5500)
2017 Schedule R (Form 55) - Retirement Plan Information (Clean)
170203 Clean Sch MB.pdf
Yes
Yes
Fillable Fileable Signable
Form
2017 Schedule SB (Form 5500)
2017 Schedule SB (Form 5500) - Single-Employer Defined Benefit Plan Actuarial Information (Clean)
170203 Clean Sch SB.pdf
Yes
Yes
Fillable Fileable Signable
Instruction
2017 Form 5500 Instructions CLEAN 032317.pdf
Yes
No
Printable Only
Instruction
2017 Form 5500SF Instruction CLEAN 032317.pdf
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
23,700
Number of Respondents for Small Entity:
17,300
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
23,700
0
0
0
0
23,700
Annual IC Time Burden (Hours)
1,200
0
0
15
0
1,185
Annual IC Cost Burden (Dollars)
1,655,000
0
0
0
0
1,655,000
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.