Annual Information Return/Report

ICR 201910-1212-003

OMB: 1212-0057

Federal Form Document

Forms and Documents
Document
Name
Status
Justification for No Material/Nonsubstantive Change
2019-10-07
Justification for No Material/Nonsubstantive Change
2019-03-28
Supporting Statement A
2019-10-07
IC Document Collections
IC ID
Document
Title
Status
13607
Modified
ICR Details
1212-0057 201910-1212-003
Historical Active 201903-1212-002
PBGC
Annual Information Return/Report
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 10/15/2019
Retrieve Notice of Action (NOA) 10/07/2019
  Inventory as of this Action Requested Previously Approved
01/31/2022 01/31/2022 01/31/2022
23,900 0 23,900
1,217 0 1,217
1,531,000 0 1,531,000

Sections 104 and 4065 of ERISA require plan administrators to file an annual report. The report must contain the information described in section 103 of ERISA. The Form 5500 Series provides a standard format for fulfilling that requirement.

US Code: 29 USC 1302(b)(3), 1365 Name of Law: ERISA
  
Statute at Large: 120 Stat. 780 Name of Statute: Pension Protection Act of 2006

Not associated with rulemaking

  83 FR 42172 08/20/2018
83 FR 56886 11/14/2018
Yes

1
IC Title Form No. Form Name
Annual Information Return/Report 2019 Schedule G (Form 5500), 2019 Schedule G (Form 5500), 2019 Schedule I (Form 5500), 2019 Schedule I (Form 5500), 2019 Schedule SB (Form 5500), 2019 Schedule MB (Form 5500), 2019 Schedule MB (Form 5500), 2019 Schedule D (Form 5500), 5500SF, 2019 Schedule MB (Form 5500), 2019 Schedule SB (Form 5500), 2019 Schedule R (Form 5500), 2019 Schedule H (Form 5500), 2019 Schedule H (Form 5500), 2019 Schedule R (Form 5500), 2019 Schedule R (Form 5500), 2019 Schedule D (Form 5500), 2019 Schedule SB (Form 5500)

  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 23,900 23,900 0 0 0 0
Annual Time Burden (Hours) 1,217 1,217 0 0 0 0
Annual Cost Burden (Dollars) 1,531,000 1,531,000 0 0 0 0
No
No

$750,000
No
    No
    No
No
No
No
Uncollected
Karen Levin 202 326-4400 ext. 3559 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/07/2019


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