Information Collection

Summary Prospectus to Everyone Affected

IC 13347 under ICR 202212-1210-004 · OMB 1210-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0049 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
pte77-4.pdf	Other-Federal Register Notice
pte77-4.pdf	Other-Federal Register Notice

IC Title:

Summary Prospectus to Everyone Affected

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Federal Register Notice			pte77-4.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: 825

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, 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	270,502	16,272	254,230
Annual IC Time Burden (Hours)	22,954	1,345	21,609
Annual IC Cost Burden (Dollars)	0	-94,142	94,142

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.