Information Collection

Notice of Insolvency (29 CFR Part 4245)

IC 13555 under ICR 201812-1212-002 · OMB 1212-0033.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0033 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 001 Notice of Insolvency (29 CFR Part 4245)	Form
Ppsd.Terminated Insolvent Reg Instructions.7-11-18.pdf efilingportal.pbgc.gov/site/	Instruction
001 Notice of Insolvency Ppsd.Notice of Insolvency 7-11-18.pdf efilingportal.pbgc.gov/site/	Form
002 Notice of Insolvency Benefit Level Ppsd.Notice of Insolvency Benefit Level 7-11-18.pdf efilingportal.pbgc.gov/site/	Form
003 Combined NOI and NOIBL Ppsd.Combined NOI and NOIBL 7-11-18.pdf efilingportal.pbgc.gov/site/	Form

IC Title:

Notice of Insolvency (29 CFR Part 4245)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4245

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	001	Notice of Insolvency	Ppsd.Notice of Insolvency 7-11-18.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form	002	Notice of Insolvency Benefit Level	Ppsd.Notice of Insolvency Benefit Level 7-11-18.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form	003	Combined NOI and NOIBL	Ppsd.Combined NOI and NOIBL 7-11-18.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Instruction			Ppsd.Terminated Insolvent Reg Instructions.7-11-18.pdf	https://efilingportal.pbgc.gov/site/	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,038	-1,560	2,598
Annual IC Time Burden (Hours)	16	-4	20
Annual IC Cost Burden (Dollars)	10,000	-2,000	12,000

Documents for IC

table that charts IC Documents
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.