Notice of Failure to Make Required Contributions

Form 200 Instructions
NOTICE OF FAILURE TO MAKE REQUIRED
CONTRIBUTIONS
The Form 200 is used to notify the Pension Benefit Guaranty Corporation of a failure to make required
contributions to a single-employer plan that is covered under ERISA §4021and whose FTAP is less than 100% if
the total of unpaid balances, including interest, exceeds $1 million (see ERISA section 303(k)(4)(A) and Code
§430(k)(4)(A)). For questions regarding this form, contact (202) 326-4070 or [email protected].

Table of Contents

Page

Introduction

1

General Instructions

3

Definitions

4

Specific Instructions

5

General Plan Information

5

Plan Funding Information

5

Additional Information to be Filed

6

Actuarial Information

6

Certifications

7

Appendix – Example of Calculation Concerning Failure to Make
Required Funding Payments

A-1

Form 200 Instructions

INTRODUCTION
ERISA §303(k) and Code §430(k) provide that a lien
arises in certain cases where there is a failure to make
required contributions to a single-employer plan
covered under ERISA §4021 whose funding target
attainment percentage (as defined in ERISA §303(d)
(2) and Code §430(d)(2)) is less than 100 percent. The
lien arises, in favor of the plan, upon all proper- ty and
rights to property (whether real or personal) belonging
to the person or persons who are liable for required
contributions (i.e., a contributing sponsor and each
member of the controlled group of which that
contributing sponsor is a member) if:

er the controlled group of which a contributing
sponsor is a member is a “parent-subsidiary,”
“brother-sister,” or “combined” group), the
imposition of the lien on all assets of each
controlled group member, or the ability of PBGC
to take all appropriate steps to perfect and
enforce the lien.

PBGC has restricted Form 200 to information
generally needed in its decision-making regarding
enforcement of a lien imposed by ERISA §303(k)
and Code §430(k). If PBGC concludes that it needs
additional information in a particular case, it will
notify (in writing) the person required to supplement
the Form 200 and specify the date by which the
1. any person fails to make a required contribu- additional information must be submitted.
tion payment when due, and
What’s New
2. the unpaid balance of the payment (including
interest), when added to the aggregate unpaid The Form 200 instructions and Form 200 have been
balance of all preceding such payments for changed as follows:
which payment was not made when due (in• PBGC's new e-filing portal offers a secure
cluding interest), exceeds $1 million.
application for submitting Form 200 information.
The application will review filings and generate a
Any lien imposed for failure to make required
list of omissions and inconsistencies prior to
contributions may be perfected and enforced only by
submission to ensure that filings are complete.
PBGC or, at its direction, by the plan’s contributing
The web-based application walks the filer through
sponsor or any member of the contributing sponsor’s
various screens, prompting the filer to answer
controlled group. ERISA §303(k)(4)(A) and Code
questions and enter required information. The
§430(k)(4)(A) require that PBGC be notified whenapplication allows filers to, among other things:
ever there is a failure to make a required payment and
– Save a partially completed filing;
the total of unpaid balances (including interest)
– Modify information any time prior to
exceeds $1 million. Notice must be provided within 10
submission;
days of the due date for the required payment.
– Pre-populate a filing with data from a
previously submitted filing;
To comply with this notification requirement, PBGC
– Route the filing as needed to facilitate eregulations (29 CFR 4043.81) require that a contribcertifications; and
uting sponsor and, if that contributing sponsor is a
– Review prior filings submitted via the e-filing
member of a parent-subsidiary controlled group, the
portal.
“ultimate parent,” file Form 200 whenever such a
The portal can be accessed using the following
failure occurs.
address: efilingportal.pbgc.gov.
Note: PBGC’s decision not to require (at this time)
controlled group members other than contributing • The Notice Due Date, Notice Filing Date and reason
for late failing have been added to the Form.
sponsors and ultimate parents to file Form 200
does not in any way limit the joint-and-several
liability of each controlled group member for
required payments (wheth-

Form 200 Instructions
Notification of future changes to any forms and instructions may be found under “What’s New” on the
Practitioners Page at www.pbgc.gov.

Form 200 Instructions

GENERAL INSTRUCTIONS
Who Must File
Form 200 must be filed by (1) a contributing sponsor and (2) if a contributing sponsor is a member of
a “parent-subsidiary” controlled group, the ultimate
parent of such group. However, if a timely and
complete Form 200 is properly filed by either a
contributing sponsor or the ultimate parent, PBGC
will deem the other to have so filed. (As noted in
the “Introduction,” each other member of any
controlled group of which a contributing sponsor
is a member also is jointly and severally liable for
required payments, and PBGC may enforce the
statutory lien imposed on its assets.)

If you are filing materials electronically that are
larger than 10 megabytess, please use Leap- FILE.
Enter “pbgc.leapfile.com” in your internet
browser, click on “secure upload,” enter
“[email protected]” in the “Recipient Email”
field, and attach the files.
When to File
Form 200, including all required documentation and
information, must be filed with PBGC no later than 10
days after the due date for the required payment.
Note: Form 200 must be filed each time there is a
failure described in ERISA § 303(k)(1) and Code §
430(k)(1) and the total of unpaid balances of required
payments (including interest) exceeds $1 million.
Notice Filing Date

Note: An authorized representative may file a Form
200 on behalf of a contributing sponsor, a parent, or
both.
Special Rule for Terminating Plans: The fact that a
plan is in the process of terminating does not mean
that a Form 200 notice need not be filed. However, a
notice is waived if the deadline for filing the notice
is on or after the date on which (1) all of the plan’s
assets (other than any excess assets) are distributed
pursuant to a termination or (2) a trustee is
appointed for the plan under ERISA §4042(c).
How to File
All required information must be filed using
the Form 200 in accordance with the instructions
posted on PBGC’s website (www.pbgc. gov). All
filings should be submitted via email
to
[email protected] or filed through PBGC’s efiling portal. To request an exemption from efiling,
send
a request
via
email
to
[email protected].

The date a Form 200 is considered to have been filed
is the date the notice and all additional required
information
is
received
by
PBGC
at
[email protected] or the date received through
PBGC’s e-filing portal. See 29 CFR § 4000.29.
Computation of time: In computing the 10-day
period, the due date of the payment that resulted in
the requirement to notify PBGC is not included.
Form 200 is due 10 days thereafter unless that day is
a Saturday, Sunday, or Federal holiday, in which case
the 10-day period runs until the next day that is not a
Saturday, Sunday, or Federal holiday.
Information
received on a weekend or Federal holiday or after 5:00
p.m. on a weekday is considered filed on the next
regular business day.
What to File
A contributing sponsor must use the PBGC Form 200 to
file a notice of a failure to make required contributions. Certain individual items on the form call for
additional information.

Attaching files
Attachments
Filers may attach electronic files to their submission. Examples of files that may be attached
include, but are not limited to, actuarial valuation
reports, financial statements, and organizational
charts.

If responding to an item requires the attachment of
documentation or information, mark the attachment to
identify the item to which it responds.

Form 200 Instructions
Previously Submitted Information
Because ERISA §303(k)(4)(A) and Code §430(k)(4)
(A) require that PBGC be notified each time there is a
failure to make a required payment and the total of
unpaid balances of required payments (including
interest) exceeds $1 million, more than one filing may
be required regarding the same plan, and at least some
of the information included in a previous Form 200
filing may continue to be accurate and responsive at
the time that a subsequent Form 200 must be filed. It
also is possible that information submitted to PBGC in
another context (e.g., in a distress termination filing
pursuant to ERISA §4041(c) or in a notice of a
reportable event required by 29 CFR Part 4043) is
responsive. A filer may respond to an item that calls
for previously submitted documentation or other
information by identifying the previous submission
in which the response was provided.

Copies of Form 200 and instructions may be obtained
from PBGC’s website at http://www.pbgc.gov/prac/
forms.html.
Reportable Event
A failure to make a required contribution may also be a
reportable event under 29 CFR 4043.25(a). If with
respect to such failure, a Form 200 is completed and
submitted in accordance with 29 CFR 4043.81, the
Form 200 filing is deemed to satisfy the reportable
event requirement (see 29 CFR 4043.25(b)).

Note: If a contributing sponsor or controlled group
member files a complete Form 200 with PBGC within
10 days of the due date of the payment in accordance
with 29 CFR §4043.81, the Form 200 filing satisfies
the notice requirement for purposes of 29 CFR
4043.25(a). However, Form 10 may also be filed if
desired. Choosing to rely on Form 200 to satisfy the
Effect of Failure to Timely File
Form 10 filing requirement does not make the Form 200
a reportable event filing under ERISA §4043 and does
If a Form 200 (or other required information) is not not give the Form 200 filing the benefit of the
provided within the specified time limit, PBGC may confidentiality protection for reportable event
assess a penalty under ERISA §4071 against each notices under ERISA §4043(f).
person required to provide the Form 200 (see 29 CFR
Part 4071 and PBGC’s Statement of Policy on
Assessment of Penalties for Failure to Provide DEFINITIONS
Required Information (60 FR 36837, July 18, 1995)).
PBGC may pursue any other equitable or legal As used in PBGC Form 200 and these instructions:
remedies available to it under the law.
For Questions or Problems Regarding Form 200
If you have questions or problems regarding Form
200 or these instructions, contact:
Pension Benefit Guaranty Corporation
Corporate Finance and Restructuring Department
1200 K Street, NW Washington
DC 20005-4026 Telephone:
202-326-4070 Email:
[email protected]
If you are having problems using the e-filing portal,
contact PBGC at [email protected].
TTY/ASCII users may call the Federal Relay Service
toll-free at 1-800-877-8339 and ask to be connected
to 202-326-4070.

Code means the Internal Revenue Code of 1986, as
amended.
Contributing sponsor means a person that is a
contributing sponsor as defined in ERISA §4001(a)
(13).
Controlled group, for purposes of ERISA §303(k)
and Code §430(k), means any group treated as a
single employer under subsection (b), (c), (m), or
(o) of Code §414.
Due date means the date set forth in ERISA §303(j)
and Code §430(j) for payment of a required installment and, in the case of a payment other than a required installment, the date such payment is required
to be made under ERISA §303 and Code §430.
EIN/PN means the nine-digit employer identifi-

Form 200 Instructions
cation number assigned by the Internal Revenue
Service to a person and the three-digit plan number assigned to a plan. The EIN/PN should be the
EIN/PN most recently reported for a PBGC premium filing (if applicable).

•

•

ERISA means the Employee Retirement Income
Security Act of 1974, as amended.
IRS means the Internal Revenue Service.
•
Notice due date means the deadline for filing a
Form 200 with PBGC.
Notice Filing Date means the date the Form 200
is received by PBGC.
Person means an individual, partnership, joint
venture, corporation, mutual company, joint-stock
company, trust, estate, unincorporated organization, association, or employee organization.

•

Complete name of the plan as it appears on the
plan document and the plan year commencement
date
The EIN/PN reported should be the EIN/PN most
recently reported for a PBGC premium filing (if
applicable). If the plan has never made a PBGC
premium filing, enter the EIN assigned to the
contributing sponsor by the IRS for income tax
purposes and the PN assigned by the
contributing sponsor.
Name, address, telephone number, and email
address of the individual or the board or other
entity, if any, specifically designated as plan
administrator by the terms of the plan or trust
agreement. If none is so designated, enter the
name, address, telephone number, and email
address of the contributing sponsor.
The name, title, e-mail address, and phone
number of an individual whom PBGC should
contact if it has questions about the filing.

Plan Funding Information
Required installment means any of the four quarterly contribution payments required for each plan
year by ERISA §303(j) and Code §430(j).
Required payment means a required installment or
other payment required under ERISA §§ 302 and 303
and Code §§ 412 and 430 or as a result of a funding
waiver.

Note: An enrolled actuary must certify that the
information in this section is true, correct, and
complete, and conforms to applicable regulatory
requirements (see Certification section).
•
•

Single-employer plan means any defined benefit
plan (as defined in ERISA §3(35)) that is not a
multiemployer plan (as defined in ERISA §4001(a)
(3)) and that is covered by title IV of ERISA.
Ultimate Parent means the parent at the highest
level in the chain of corporation and/or other organizations constituting a parent-subsidiary controlled
group. (For example, if Corporation A owns all of the
stock of Corporation B and Corporation C, and
Corporation B owns all of the stock of Corporation
X, the contributing sponsor, then the “ultimate
parent” of Corporation X is Corporation A.)

SPECIFIC INSTRUCTIONS
General Plan Information

•

Due date of required payment.
The total amount, as of the due date, of the
unpaid balance of the required payment and the
aggregate unpaid balance of all preceding required
payments for which payment was not made when
due (i.e., include in this amount the unpaid balances,
including interest, of all required payments for
which payment was not made when due). See
Appendix for an example of how to compute the
total amount.
Description of how the unpaid balance of
required payments was determined. This
description must include an attached spreadsheet
that shows the details of the calculation (see
Appendix for an example of how the required
information may be shown).

Form 200 Instructions
Additional Information to be Filed

Also include an explanation of any information
required to be filed but missing from the filing.

Additional information to be filed (check all boxes
for information attached to form; see below for
description of Actuarial Information required).
•

•
•
•

•
•
•

•

•

Description of the plan’s controlled group structure
(including the contributing sponsor and the ultimate
parent of the controlled group), including the name,
address, telephone number, and EIN of each controlled group member
Location of real property owned by each controlled group member
Name and address of the controlled group’s principal executive office
Operational status of each controlled group
member (in Chapter 7 proceedings, liquidating
outside of bankruptcy, in Chapter 11
proceedings, on-going, etc.)
Name, address, telephone number and EIN of
each contributing sponsor of the plan
Reason contribution was not made by due date
Copy of any IRS letter(s) granting or modifying
a funding waiver and/or extension of the
amortization period
Statement describing any pending request(s) for
a funding waiver and/or extension of the
amortization period
Copies of audited financial statements (if
available) or (if not) unaudited financial statements that were prepared for the contributing
sponsor and each other controlled group member individually, including balance sheets,
income statements, statements of cash flows,
and notes to financial statements and annual
reports. However, if financial statements were
only prepared on a consolidated basis for more
than one controlled group member, consolidated financial statements and consolidating
financial statements (if available) and (if not)
consolidating trial balances that identify each
controlled group member individually may
be attached instead. Copies of financial statements for the most recent three fiscal years
available, and the most recent available interim financial statement, for each member of the
plan’s controlled group, including the contributing sponsor and the ultimate parent

Note – Simplified Reporting: Most “Additional
Information to be Filed” does not need to be
submitted if the filer has not missed any required
contribution (other than the missed contribution that
triggered the Form 200 filing requirement) during
the two-year period ending on the notice due date
for the Form 200 and has made up the missed
contribution by the notice due date. The only
additional information required is the reason the
contribution was not made by the due date. PBGC
may also request evidence that the contribution has
been made. The filer should note Simplified
Reporting is being used in the missing information
section of the filing.
Actuarial Information
Please include the following for each plan maintained by any member of the plan’s controlled group:
•

Copy of the most recent Actuarial Valuation
Report that includes or is supplemented with all of
the items described below. If the amount of the
most recent missed contribution is based on a
calculation that is not reflected in the most recent
Actuarial Valuation Report, also provide all of the
information described below that supports the
calculation:

– The funding target calculated pursuant to ERISA
section 303 without regard to sub- section
303(i)(1), setting forth separately the value of the
liabilities
attributable
to
retirees
and
beneficiaries receiving
payment, terminated
vested participants, and active participants (showing
vested and non-vested benefits separately;
– A summary of the actuarial assumptions and
methods used for purposes of ERISA section 303
and any changes in those assumptions and methods
since the previous valuation and justifications for
any change; in the case of a plan that provides
lump sums, other than de mini- mis lump sums,
the summary must include the assumptions on
which participants are assumed to elect a lump
sum and how lump sums are valued;
– The effective interest rate (as defined in ER- ISA

Form 200 Instructions
section 303(h)(2)(A)
430(h)(2)(A));

and

Code

section

benefit provisions on which the valuation of the
plan was based (and any changes to those
provisions since the previous valuation), along
with descriptions of any benefits not included in
the valuation, any significant events that occurred during the plan year, and the plan’s early
retirement factors; in the case of a plan that
provides lump sums, other than de minimis lump
sums, the summary must include information on
how annuity benefits are converted to lump sum
amounts (for example, whether early retirement
subsidies are reflected).

– The target normal cost calculated pursuant to
ERISA section 303 without regard to subsection
303(i)(2) (and Code section 430 without regard to
subsection 430(i)(2));
– For the plan year and the four preceding plan
years, a statement as to whether the plan was
in at-risk status for that plan year;
– In the case of a plan that is in at-risk status, the
target normal cost calculated pursuant to ERISA section 303 as if the plan has been in at-risk
status for 5 consecutive years;
– The value of the plan’s assets (reflecting any
averaging method) as of the valuation date and
the fair market value of the plan’s assets as of
the valuation date;
– The funding standard carryover balance and
the prefunding balance (maintained pursuant
to ERISA section 303(f)(1) and Code section
430(f)(1)) as of the beginning of the plan year
and a summary of any changes in such balances in the past year (e.g., amounts used to offset minimum funding requirement, amounts
reduced in accordance with any elections under ERISA section 303(f)(5) or Code section
430(f)(5), interest credited to such balances,
and excess contributions used to increase such
balances);
– A list of amortization bases (shortfall and
waiver) under ERISA section 303 and Code
section 430, including the year the base was
established, the original amount, the installment amount, and the remaining balance at the
beginning of the plan year;
– An age/service scatter for active participants
including average compensation information
for pay-related plans and average account
balance information for hybrid plans presented in a format similar to that described in the instructions to Schedule SB of
the Form 5500;
– Expected disbursements (benefit payments and
expenses) during the plan year; and
– A summary of the principal eligibility and

•

•
•

•

Statement of any material change in liabilities of
the plan occurring after the date of the most recent Actuarial Valuation Report.
Most recent month-end market value of plan assets.
Contact name, telephone number, and employer of the plan actuary if different from that
listed on the most recently filed Schedule SB to
Form 5500.
Copies of election letters relating to the application of carryover or prefunding balances to the
contributions.

Certifications
• Plan funding information and related explanation
certification must be made by an enrolled actuary
• Contributing Sponsor or Parent Certification
must be made by an officer (or an individual of
comparable authority in an unincorporated
organization) of the contributing sponsor
or ultimate parent that is filing the Form
200.

Form 200 Instructions

APPENDIX
Example on How to Describe the Aggregate Unpaid Balance of Required Funding Payments
Assume the plan sponsor of a calendar-year plan:
•
•
•
•
•

missed a required 2017 quarterly installment of $600,000 on January 15, 2018
made a contribution of $200,000 on March 1, 2018
missed a 2018 required quarterly installment of $500,000 on April 15, 2018
missed a 2018 required quarterly installment of $500,000 on July 15, 2018
missed the final 2017 required contribution of $150,000 on September 15, 2018

In addition, assume the effective interest rate for plan year 2017 was 8% and for plan year 2018 was 6%. Adding 5%
(see ERISA §303(j)(3)(A)) to the effective interest rates for the periods of underpayment, the applicable interest
rates for the missed quarterlies for the 2017 and 2018 plan years are 13% and 11%, respectively.
Aggregate Unpaid Balance of Required Contributions as of 7/15/2018
Date

Applicable
Plan Year

Applicable
Interest Rate

Amount

Missed contribution
01/15/2018 Quarterly
04/15/2018 Quarterly

2017

13.00%

$600,000

2018

$500,000

07/15/2018

Quarterly

2018

11.00%
11.00%

Payment made
03/01/2018
Quarterly

2017

13.00%

Total

Days until
07/15/2018

Interest
Adjustment

Total

181

$37,488

$637,488
$513,180

$500,000

91
0

$13,180
$0

($200,000)

136

$1,400,000

$500,000

($9,318)

($209,318)

$41,350

$1,441,350

Because the aggregate unpaid balance of required payments as of July 15, 2018 ($1,441,350) exceeds $1,000,000,
a Form 200 filing is due on July 25, 2018 (10 days after the missed contribution, with weekend extension). The
table shown above is an example of the data to be submitted with the Form 200 filing.

A-1

Form 200 Instructions

Aggregate Unpaid Balance of Required Contributions as of 9/15/2018
Applicable
Plan Year

Date

Applicable
Interest Rate

Amount

Missed contribution
01/15/2018 Quarterly
04/15/2018 Quarterly

2017

13.00%

$600,000

2018

$500,000

07/15/2018

Quarterly

2018

11.00%
11.00%

09/15/2018

Final

2017

2017

Days until
09/15/2018

Interest
Adjustment

Total

243

$50,861

$650,861
$522,358

$500,000

153
62

$22,358
$8.942

8.00%

$150,000

0

$0

$150,000

13.00%

($200,000)

198

$508,942

Payment made
03/01/2018

Total

Quarterly

$1,400,000

($13,709)

($213,709)

$68,452

$1,618,452

Because the aggregate unpaid balance of required payments as of September 15, 2018 ($1,618,452) exceeds
$1,000,000, an updated Form 200 filing is due on September 25, 2018 (10 days after the missed contribution,
with weekend extension). The table shown above is an example of the data to be submitted with the Form 200
filing.

Form 200 Instructions

PAPERWORK REDUCTION ACT NOTICE
PBGC needs this information, which is required to be filed under ERISA §303(k)(4) and the Internal Revenue
Code §430(k)(4) and 29 CFR Part 4043, Subparts A and D, to make decisions regarding enforcement of a lien
imposed by ERISA §303(k)(1) and Code §430(k)(1). Information provided to PBGC is confidential to the
extent provided in the Freedom of Information Act and the Privacy Act.
PBGC estimates that it will take an average of 1 hour and $725 to comply with the requirements described in
these instructions. These figures are estimated averages that will vary depending on the nature and organizational structure of persons liable for plan contributions (in particular, whether the plan’s contributing sponsor
is a member of a controlled group and, if so, the size of that group) and on the funding history of the plan.
If you have any comments concerning the accuracy of these time estimates or suggestions for improving the
form or these instructions, please send your comments to the Pension Benefit Guaranty Corporation, Regulatory Affairs Group, Office of the General Counsel, 1200 K Street, NW, Washington, DC 20005-4026.
This collection of information has been approved by the Office of Management and Budget (OMB) under
control number [pending] and expires on XX,XXXX. An agency may not conduct or sponsor, and a person
is not required to respond to, a collection of information unless it displays a currently valid OMB

A-2