OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

PBGC Premium Filer Questionnaire

IC 234855 under ICR 201805-1090-002 · OMB 1090-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

2021-09-21 - Extension without change of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 042 PBGC Premium Filer Questionnaire	Form and Instruction
042 PBGC Premium Filer Questionnaire PBGC Premium Filer Questionnaire 2019_FINAL.docx	Form and Instruction
Generic Clearance Request signed.pdf Generic Clearance Form	IC Document
OMB Mapping Cover PBGC #042.xlsx OMB Mapping Cover for #042	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

PBGC Premium Filer Questionnaire

Agency IC Tracking Number:

042

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	042	PBGC Premium Filer Questionnaire	PBGC Premium Filer Questionnaire 2019_FINAL.docx		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	250	0	250	0	0	0
Annual IC Time Burden (Hours)	50	0	50	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Clearance Form	Generic Clearance Request signed.pdf	02/05/2019
OMB Mapping Cover for #042	OMB Mapping Cover PBGC #042.xlsx	02/05/2019

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