Pension Benefit Statement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Lifetime Income SS 9-15-2021 FINAL.docx	Supporting Statement A	Uploaded 2021-09-17	Repair queued
29 CFR 2520.pdf	Supplementary Document	Uploaded 2020-09-21	Repair queued
29 USC 1104.pdf	Supplementary Document	Uploaded 2020-09-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
242407	Pension Benefit Statement	Other-Model	Modified

ICR Details

OMB Control No: 1210-0166	ICR Reference No: 202108-1210-004
Status: Historical Active	Previous ICR Reference No: 202006-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Pension Benefit Statement
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/29/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/17/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2024	36 Months From Approved
Responses	410,933,333	0	0
Time Burden (Hours)	19,675	0	0
Cost Burden (Dollars)	498,958,393	0	0

---

Abstract: This ICR contains the information that must be provided on pension benefit statements required by section 105 of the Employee Retirement Income Security Act of 1974. These Interim Final Regulation add a requirement that plan administrators of ERISA defined contribution plans must express a participant’s current account balance, both as a single life annuity and a qualified joint and survivor annuity income stream.

---

Authorizing Statute(s): US Code: 29 USC 1104 Name of Law: Employee Retirement Income Security Act of 1974
  

Citations for New Statutory Requirements: PL: Pub.L. 116 - 94 O Name of Law: Consolidated Appropriations Act, 2021

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1210-AB20	Final or interim final rulemaking	85 FR 59132	09/18/2020

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Pension Benefit Statement

---

ICR Summary of Burden

table that charts list of burden

	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	410,933,333	0	410,933,333	0	0	0
Annual Time Burden (Hours)	19,675	0	19,675	0	0	0
Annual Cost Burden (Dollars)	498,958,393	0	498,958,393	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/17/2021

---