Information Collection

Registration Requirements to Serve as a Pooled Plan Provider to Pooled Employer Plans

IC 241148 under ICR 202004-1210-001 · OMB 1210-0164.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0164 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PR Registration Requirements to Serve as a Pooled Plan Provider to Pooled Employer Plans	Form and Instruction
PR Form PR Form PR and Instructions 8.18.2020.docx	Form and Instruction

IC Title:

Registration Requirements to Serve as a Pooled Plan Provider to Pooled Employer Plans

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2510

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 and Instruction	PR	Form PR	Form PR and Instructions 8.18.2020.docx		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: 1,660

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	2,813	2,813
Annual IC Time Burden (Hours)	1,676	1,676
Annual IC Cost Burden (Dollars)	0	0

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.