Information Collection

Reportable Events

IC 13522 under ICR 201911-1212-002 · OMB 1212-0013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0013 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 10 Reportable Events	Form
Final Form-10-AdvanceInstructions to OMB.pdf www.pbgc.gov	Instruction
Final Form-10 Instructions to OMB.pdf www.pbgc.gov	Instruction
4043 module screenshots.pdf www.pbgc.gov	Other-Illustrative screenshots
Form 10-Advance Advance Notice of Reportable Events Final Form-10-Advance to OMB.pdf www.pbgc.gov	Form
Form 10 Post-Event Notice of Reportable Events Final Form-10 to OMB Feb.25.pdf www.pbgc.gov	Form

IC Title:

Reportable Events

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

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	Form 10	Post-Event Notice of Reportable Events	Final Form-10 to OMB Feb.25.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Form	Form 10-Advance	Advance Notice of Reportable Events	Final Form-10-Advance to OMB.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Instruction			Final Form-10-AdvanceInstructions to OMB.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Instruction			Final Form-10 Instructions to OMB.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Other-Illustrative screenshots			4043 module screenshots.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 522

Number of Respondents for Small Entity: 286

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	522	-68	590
Annual IC Time Burden (Hours)	1,641	-214	1,855
Annual IC Cost Burden (Dollars)	388,890	-50,660	439,550

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.