Information Collection

Survey of Multiemployer Pension Plan Withdrawal Liability Information

IC 232801 under ICR 202109-1212-009 · OMB 1212-0071.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Copy of Withdrawal Liability Survey Template 10-19-18.xlsx	Other-Survey Template
Copy of Withdrawal Liability Survey Template 10-19-18.xlsx	Other-Survey Template
Withdrawal Liability Survey Paperwork Reduction Act Notice.docx Withdrawal Liability Survey PRA Notice	IC Document
Withdrawal Liability Survey Paperwork Reduction Act Notice.docx Withdrawal Liability Survey PRA Notice	IC Document
Sample cover email withdrawal liability survey.docx Sample Cover Email for Withdrawal Liability Survey	IC Document
Sample cover email withdrawal liability survey.docx Sample Cover Email for Withdrawal Liability Survey	IC Document

IC Title:

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
Other-Survey Template			Copy of Withdrawal Liability Survey Template 10-19-18.xlsx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: 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	6	-59	65
Annual IC Time Burden (Hours)	60	-590	650
Annual IC Cost Burden (Dollars)	24,000	-236,000	260,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Withdrawal Liability Survey PRA Notice	Withdrawal Liability Survey Paperwork Reduction Act Notice.docx	10/31/2018
Sample Cover Email for Withdrawal Liability Survey	Sample cover email withdrawal liability survey.docx	10/31/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.