Information Collection

Reportable Events

IC 13522 under ICR 202106-1212-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form-10-Instructions_Revised_Clean.docx	Instruction
Form-10-Instructions_Revised_Clean.docx	Instruction
Form-10-AdvanceInstructions_Revised_Clean.docx	Instruction
Form-10-AdvanceInstructions_Revised_Clean.docx	Instruction
4043 screenshots_Revised April 2021.docx	Other-Screen shots
4043 screenshots_Revised April 2021.docx	Other-Screen shots
Form 10 Post-Event Notice of Reportable Events Form-10_Revised_Clean.docx	Form
Form 10 Post-Event Notice of Reportable Events Form-10_Revised_Clean.docx	Form
Form 10-Advance Advance Notice of Reportable Events Form-10-Advance.docx	Form
Form 10-Advance Advance Notice of Reportable Events Form-10-Advance.docx	Form

IC Title:

Reportable Events

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4043

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form 10	Post-Event Notice of Reportable Events	Form-10_Revised_Clean.docx	Yes	Yes	Fillable Fileable Signable
Instruction			Form-10-Instructions_Revised_Clean.docx	Yes	Yes	Fillable Fileable Signable
Form	Form 10-Advance	Advance Notice of Reportable Events	Form-10-Advance.docx	Yes	Yes	Fillable Fileable Signable
Instruction			Form-10-AdvanceInstructions_Revised_Clean.docx	Yes	Yes	Fillable Fileable Signable
Other-Screen shots			4043 screenshots_Revised April 2021.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: 573

Number of Respondents for Small Entity: 0

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	573	51	522
Annual IC Time Burden (Hours)	1,802	161	1,641
Annual IC Cost Burden (Dollars)	426,885	37,995	388,890

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.