Information Collection

Settlement Agreements Between a Plan and Party in Interest

IC 13416 under ICR 202201-1210-005 · OMB 1210-0091.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0091 can be found here:

Documents and Forms

Information Collection (IC) Details

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IC Title:	Settlement Agreements Between a Plan and Party in Interest	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-PTE 94-71			PTE 94-71.doc		Yes	No	Printable Only
Other-PTE 2003-39			pte 2003-39.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 58 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	810	-4,320	4,050	1,080
Annual IC Time Burden (Hours)	16	-84	77	23
Annual IC Cost Burden (Dollars)	214	-1,137	1,076	275

Documents for IC

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.