Information Collection

ERISA Summary Annual Report Requirement

IC 13341 under ICR 201909-1210-004 · OMB 1210-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Model Summary Annual Report Relating to Pension Plans.docx	Other-Model Form for Pension Plans
Model Summary Annual Report Relating to Welfare Plans.docx	Other-Model Form for Welfare Plans

IC Title:

ERISA Summary Annual Report Requirement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2520.104b-10 29 CFR 2520.104(b)-1(b) 29 CFR 2520.104(b)-1(c)

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
Other-Model Form for Welfare Plans			Model Summary Annual Report Relating to Welfare Plans.docx		Yes	No	Fillable Printable
Other-Model Form for Pension Plans			Model Summary Annual Report Relating to Pension Plans.docx		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 743,628

Number of Respondents for Small Entity: 624,435

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 56 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	170,628,651	0	170,628,651
Annual IC Time Burden (Hours)	1,817,006	0	1,817,006
Annual IC Cost Burden (Dollars)	25,429,562	-23,794,114	49,223,676

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.