Information Collection

Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)

IC 13583 under ICR 202301-1212-001 · OMB 1212-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0049 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Appendix 1 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)	Form
4010 e-Filing Portal screenshots to OMB.pdf www.pbgc.gov	Other-screenshots
4010 e-Filing Portal screenshots to OMB.pdf www.pbgc.gov	Other-screenshots
Final Appendix 2 - 4010 illustrative instructions to OMB.d2.pdf www.pbgc.gov	Instruction
Final Appendix 2 - 4010 illustrative instructions to OMB.d2.pdf www.pbgc.gov	Instruction
Appendix 1 Appendix 1 - 4010 Illustrative form Final Appendix 1 - 4010 illustrative form to OMB.pdf www.pbgc.gov	Form
Appendix 1 Appendix 1 - 4010 Illustrative form Final Appendix 1 - 4010 illustrative form to OMB.pdf www.pbgc.gov	Form

IC Title:

Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4010

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	Appendix 1	Appendix 1 - 4010 Illustrative form	Final Appendix 1 - 4010 illustrative form to OMB.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Other-screenshots			4010 e-Filing Portal screenshots to OMB.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Instruction			Final Appendix 2 - 4010 illustrative instructions to OMB.d2.pdf	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	400	-160	560
Annual IC Time Burden (Hours)	800	285	515
Annual IC Cost Burden (Dollars)	11,080,000	-1,783,858	12,863,858

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.