Information Collection

Termination of Single Employer Plans

IC 13567 under ICR 201802-1212-001 · OMB 1212-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Clean ST filing instructions March 2018.pdf	Instruction
Clean Distress filing instructions March 2018.pdf	Instruction
Clean Sch. MP instructions March 2018.pdf	Instruction
PBGC Form 501 Post-Distribution Certification for Standard Termination Clean Standard Termination Form 501 March 2018.pdf	Form
PBGC Form 500 Standard Termination Notice Single-Employer Plan Termina Form 500.pdf	Form
Schedule MP (to fo Missing Participant Information Clean Schedule MP forms March 2018.pdf	Form
PBGC Form 600, 601 Distress Termination - Notice to PBGC of Intent to Termi Clean Distress Termination forms March 2018.pdf	Form
Supporting Statement 2014 Final.docx Supporting Statement	IC Document

IC Title:

Termination of Single Employer Plans

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4041 29 CFR 4050

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Clean ST filing instructions March 2018.pdf	Yes	No	Paper Only
Instruction			Clean Distress filing instructions March 2018.pdf	Yes	No	Paper Only
Instruction			Clean Sch. MP instructions March 2018.pdf	Yes	No	Paper Only
Form	PBGC Form 501	Post-Distribution Certification for Standard Termination	Clean Standard Termination Form 501 March 2018.pdf	Yes	Yes	Fillable Printable
Form	PBGC Form 500	Standard Termination Notice Single-Employer Plan Termination	Form 500.pdf	Yes	Yes	Fillable Printable
Form	Schedule MP (to forms 501 and 602)	Missing Participant Information	Clean Schedule MP forms March 2018.pdf	Yes	Yes	Fillable Printable
Form	PBGC Form 600, 601, 602	Distress Termination - Notice to PBGC of Intent to Terminate; Distress Termination - Single-Employer Plan; Post-Distribution Certification for Distress Termination	Clean Distress Termination forms March 2018.pdf	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,426

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,426	-4	1,430
Annual IC Time Burden (Hours)	29,890	28,182	1,708
Annual IC Cost Burden (Dollars)	5,963,400	4,242,009	1,721,391

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Supporting Statement 2014 Final.docx	10/20/2014

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