Request for Coverage Determination

ICR 202205-1212-001

OMB: 1212-0072

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2022-05-09
IC Document Collections
IC ID
Document
Title
Status
236023 Modified
ICR Details
1212-0072 202205-1212-001
Received in OIRA 201905-1212-004
PBGC
Request for Coverage Determination
Revision of a currently approved collection   No
Regular 05/09/2022
  Requested Previously Approved
36 Months From Approved 06/30/2022
310 425
465 4,250
93,000 1,487,500

This form is used by a plan administrator or plan sponsor of a plan to request that the Pension Benefit Guaranty Corporation determine whether a plan is covered under title IV of the Employee Retirement Income Security Act of 1974.

US Code: 29 USC 1321 Name of Law: Coverage
  
None

Not associated with rulemaking

  87 FR 11492 03/01/2022
87 FR 27667 05/09/2022
No

1
IC Title Form No. Form Name
Request for Coverage Determination Request for Coverage Determination Request for Coverage Determination

  Total Request 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 310 425 0 0 -115 0
Annual Time Burden (Hours) 465 4,250 0 0 -3,785 0
Annual Cost Burden (Dollars) 93,000 1,487,500 0 0 -1,394,500 0
No
No
The changes to the estimates of hour and cost burdens of this collection of information are attributable to PBGC’s usage of experience-based burden estimation. The information on plan experience is gathered by contacting nine or fewer plan representatives. PBGC’s prior estimates of annual hour burden and cost burden for the Request for Coverage Determination form were not experienced-based, as this information collection was new at the time.

$0
No
    Yes
    Yes
No
No
No
No
Melissa Rifkin 202 326-4400 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/09/2022


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