Locating and Paying Participants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 719 Election to Withhold Federal Income Tax from Periodic Payments	Form and Instruction	Modified	Available
Form 706 Beneficiary Application for Pension Benefits	Form and Instruction	Modified	Available
Form 705 Beneficiary Application for Pension Benefits	Form and Instruction	Modified	Available
Form 700 Participant Application for Benefits	Form and Instruction	Modified	Available
Form 715 Power of Attorney (POA)	Form and Instruction	Modified	Available
Form Form 717 Benefit Inquiry Questionnaire	Form and Instruction	Modified	Available
Form Form 722 Financial Statement of Debtor	Form and Instruction	Modified	Available
Form Form 721T Tax Election for Payment Not Eligible for Rollover	Form and Instruction	Modified	Available
Form Form 721 Application for Eligible Rollover Payment - Non-Spouse Beneficiary	Form and Instruction	Modified	Available
Form Form 720MP Application for Lump-Sum Payment	Form and Instruction	Modified	Available
Form Form 720CD Application for Lump-Sum Payment	Form and Instruction	Modified	Available
Form Form 720 Application for Lump-Sum Payment	Form and Instruction	Modified	Available
Form Form 719 Election to Withhold Federal Income Tax from Periodic Payment	Form and Instruction	Modified	Available
Form Form 718 Installment Payment Agreement	Form and Instruction	Modified	Available
Form Form 716A Certificate of Pension Plan Disability Status	Form and Instruction	Modified	Repair queued
Form Form 716 Certification of Social Security Disability	Form and Instruction	Modified	Available
Form Form 714 Withdrawal of Employee Contributiions	Form and Instruction	Modified	Available
Form Form 713 Election fot Withdraw Employee Contributions	Form and Instruction	Modified	Available
Form Form 712 Uniformed Services Information Form	Form and Instruction	Modified	Available
Form Form 711 Change of Beneficiary for Certain Continuous Benefits Only	Form and Instruction	Modified	Available
Form Form 710 Application for Direct Deposit	Form and Instruction	Modified	Available
Form Form 709 Plan Participant Information	Form and Instruction	Modified	Available
Form Form 708 Designation of Beneficiary	Form and Instruction	Modified	Available
Form Form 707 Designation of Beneficiary for Benefits Owed at Death	Form and Instruction	Modified	Available
Form Form 706 Beneficiary Application for Pension Benefits	Form and Instruction	Modified	Available
Form Form 705 Beneficiary Application for Pension Benefits	Form and Instruction	Modified	Available
Form Form 700 Participant Application for Pension Benefits	Form and Instruction	Modified	Available
Form Form 704 Report of Earnings and Social Security Disability Information	Form and Instruction	Modified	Available
Form Form 703MP Application for Elective Lump-Sum Payment	Form and Instruction	Modified	Available
Form Form 703 Application for Elective Lump-Sum Payment	Form and Instruction	Modified	Available
Form Form 702 General Information	Form and Instruction	Modified	Available
Form Form 701 Payee Information	Form and Instruction	Modified	Available
Justification.withholdinginfo.d1.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2019-02-01	Available
Supporting statement paying and locating participants 2018.d2.pdf	Supporting Statement A	Uploaded 2018-08-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Election to Withhold Federal Income Tax from Periodic Payments
13603	Locating and Paying Participants	Form and Instruction	Modified	Beneficiary Application for Pension Benefits
13603	Locating and Paying Participants	Form and Instruction	Modified	Beneficiary Application for Pension Benefits
13603	Locating and Paying Participants	Form and Instruction	Modified	Participant Application for Benefits
13603	Locating and Paying Participants	Form and Instruction	Modified	Power of Attorney (POA)
13603	Locating and Paying Participants	Form and Instruction	Modified	Benefit Inquiry Questionnaire
13603	Locating and Paying Participants	Form and Instruction	Modified	Financial Statement of Debtor
13603	Locating and Paying Participants	Form and Instruction	Modified	Tax Election for Payment Not Eligible for Rollover
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Eligible Rollover Payment - Non-Spouse Beneficiary
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Election to Withhold Federal Income Tax from Periodic Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Installment Payment Agreement
13603	Locating and Paying Participants	Form and Instruction	Modified	Certificate of Pension Plan Disability Status
13603	Locating and Paying Participants	Form and Instruction	Modified	Certification of Social Security Disability
13603	Locating and Paying Participants	Form and Instruction	Modified	Withdrawal of Employee Contributiions
13603	Locating and Paying Participants	Form and Instruction	Modified	Election fot Withdraw Employee Contributions
13603	Locating and Paying Participants	Form and Instruction	Modified	Uniformed Services Information Form
13603	Locating and Paying Participants	Form and Instruction	Modified	Change of Beneficiary for Certain Continuous Benefits Only
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Direct Deposit
13603	Locating and Paying Participants	Form and Instruction	Modified	Plan Participant Information
13603	Locating and Paying Participants	Form and Instruction	Modified	Designation of Beneficiary
13603	Locating and Paying Participants	Form and Instruction	Modified	Designation of Beneficiary for Benefits Owed at Death
13603	Locating and Paying Participants	Form and Instruction	Modified	Beneficiary Application for Pension Benefits
13603	Locating and Paying Participants	Form and Instruction	Modified	Beneficiary Application for Pension Benefits
13603	Locating and Paying Participants	Form and Instruction	Modified	Participant Application for Pension Benefits
13603	Locating and Paying Participants	Form and Instruction	Modified	Report of Earnings and Social Security Disability Information
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Elective Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	Application for Elective Lump-Sum Payment
13603	Locating and Paying Participants	Form and Instruction	Modified	General Information
13603	Locating and Paying Participants	Form and Instruction	Modified	Payee Information
13603	Locating and Paying Participants	Other-Screen shots	Modified

ICR Details

OMB Control No: 1212-0055	ICR Reference No: 201902-1212-001
Status: Historical Active	Previous ICR Reference No: 201807-1212-002
Agency/Subagency: PBGC	Agency Tracking No:
Title: Locating and Paying Participants
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/04/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/01/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2021	10/31/2021	10/31/2021
Responses	175,397	0	175,397
Time Burden (Hours)	108,440	0	108,440
Cost Burden (Dollars)	56,711	0	56,711

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Abstract: This collection consists of information participants and beneficiaries are asked to provide in connection with an application for benefits or request for a benefit estimate. In addition, in some instances, as part of a search for participants and beneficiaries who may be entitled to benefits, the PBGC requests individuals to provide identifying information that the individual would provide as part of an initial contact with the PBGC.

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Authorizing Statute(s): PL: Pub.L. 109 - 280 410 Name of Law: Pension Protection Act of 2006
   US Code: 29 USC 1322, 1350 Name of Law: Employee Retirement Security Act (ERISA)
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 280 410 Name of Law: Pension Protection Act of 2006

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 22715	05/16/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 39479	08/09/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Locating and Paying Participants	706, Form 707, Form 708, Form 720, Form 709, Form 710, Form 714, Form 716, Form 716A, Form 721, Form 721T, Form 722, Form 717, Form 701, Form 702, Form 703, Form 703MP, Form 700, Form 705, Form 706, Form 711, Form 712, Form 713, Form 718, Form 719, Form 720CD, Form 720MP, Form 704, 715, 705, 719, 700	Payee Information ,   General Information ,   Application for Elective Lump-Sum Payment ,   Application for Elective Lump-Sum Payment ,   Report of Earnings and Social Security Disability Information ,   Participant Application for Pension Benefits ,   Beneficiary Application for Pension Benefits ,   Beneficiary Application for Pension Benefits ,   Designation of Beneficiary for Benefits Owed at Death ,   Designation of Beneficiary ,   Plan Participant Information ,   Application for Direct Deposit ,   Change of Beneficiary for Certain Continuous Benefits Only ,   Uniformed Services Information Form ,   Election fot Withdraw Employee Contributions ,   Withdrawal of Employee Contributiions ,   Certification of Social Security Disability ,   Certificate of Pension Plan Disability Status ,   Installment Payment Agreement ,   Election to Withhold Federal Income Tax from Periodic Payment ,   Application for Lump-Sum Payment ,   Application for Lump-Sum Payment ,   Application for Lump-Sum Payment ,   Application for Eligible Rollover Payment - Non-Spouse Beneficiary ,   Tax Election for Payment Not Eligible for Rollover ,   Financial Statement of Debtor ,   Benefit Inquiry Questionnaire ,   Power of Attorney (POA) ,   Participant Application for Benefits ,   Beneficiary Application for Pension Benefits ,   Beneficiary Application for Pension Benefits ,   Election to Withhold Federal Income Tax from Periodic Payments

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	175,397	175,397	0	0	0	0
Annual Time Burden (Hours)	108,440	108,440	0	0	0	0
Annual Cost Burden (Dollars)	56,711	56,711	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/01/2019

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