Information Collection

Termination of Multiemployer Plans (29 CFR Part 4041A)

IC 13529 under ICR 202205-1212-002 · OMB 1212-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0020 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 001 Termination of Multiemployer Plans (29 CFR Part 4041A)	Form and Instruction
Final.Terminated Insolvent Reg Instructions.5-7-19.pdf efilingportal.pbgc.gov/site/	Instruction
Final.Terminated Insolvent Reg Instructions.5-7-19.pdf efilingportal.pbgc.gov/site/	Instruction
001 Notice of Termination Final.NOT_05082019.pdf efilingportal.pbgc.gov/site/	Form and Instruction
001 Notice of Termination Final.NOT_05082019.pdf efilingportal.pbgc.gov/site/	Form and Instruction
002 Actuarial Valuation Final.Actuarial_05082019.pdf efilingportal.pbgc.gov/site/	Form and Instruction
002 Actuarial Valuation Final.Actuarial_05082019.pdf efilingportal.pbgc.gov/site/	Form and Instruction
003 Withdrawal Liability Final.Withdrawal Liability 05082019.pdf efilingportal.pbgc.gov/site/	Form and Instruction
003 Withdrawal Liability Final.Withdrawal Liability 05082019.pdf efilingportal.pbgc.gov/site/	Form and Instruction

IC Title:

Termination of Multiemployer Plans (29 CFR Part 4041A)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4041A (To search for a specific CFR, visit the Code of Federal Regulations.)

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
Form and Instruction	001	Notice of Termination	Final.NOT_05082019.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form and Instruction	002	Actuarial Valuation	Final.Actuarial_05082019.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form and Instruction	003	Withdrawal Liability	Final.Withdrawal Liability 05082019.pdf	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Instruction			Final.Terminated Insolvent Reg Instructions.5-7-19.pdf	https://efilingportal.pbgc.gov/site/	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 117

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	817	-1,483	2,300
Annual IC Time Burden (Hours)	61	-168	229
Annual IC Cost Burden (Dollars)	39,400	-74,600	114,000

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.