Information Collection Request

Special Financial Assistance by PBGC-Withdrawal Liability Condition Exception

ICR 202301-1212-002 · OMB 1212-0074 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SFA Lock-In Applic SFA Lock-In Application Form and Instruction Unchanged Available
Form SFA Filing Instruc SFA Filing Instructions, Addendum B Form and Instruction Unchanged Available
Form SFA 300 Annual Statement of Compliance Form and Instruction Unchanged Repair queued
Form SFA Filing Instruc General Instructions for Multiemployer Plans Applying for Special Financial Assistance Form and Instruction Unchanged Available
Form SFA 100 SFA Template Checklist Form and Instruction Unchanged Available
Form SFA 204-A SFA Template 4A Form and Instruction Unchanged Available
Form Model Certificatio Model Certification Form and Instruction Unchanged Available
Form Model Plan Amendme Model Plan Amendment, Reinstatement Form and Instruction Unchanged Available
Form Model Plan Amendme Model Plan Amendment, Compliance Form and Instruction Unchanged Available
Form SFA 206-B SFA Template 6B Form and Instruction Unchanged Available
Form SFA 205-B SFA Template 5B Form and Instruction Unchanged Available
Form PBGC E-filing Port PBGC E-filing Portal Form Unchanged Available
Form SFA Filing Instruc SFA Filing Instructions, Addendum D Form and Instruction Unchanged Available
Form SFA Filing Instruc SFA Filing Instructions, Addendum C Form and Instruction Unchanged Available
Form SFA Filing Instruc SFA Filing Instructions, Addendum A Form and Instruction Unchanged Available
Form SFA 100-Supplement SFA Template Checklist, Supplemented Application Form and Instruction Unchanged Available
Form SFA 209 SFA Template 9 Form and Instruction Unchanged Available
Form SFA 208 SFA Template 8 Form and Instruction Unchanged Available
Form SFA 207 SFA Template 7 Form and Instruction Unchanged Available
Form SFA 206-A SFA Template 6A Form and Instruction Unchanged Available
Form SFA 205-A SFA Template 5A Form and Instruction Unchanged Available
Form SFA 204-B SFA Template 4B Form and Instruction Unchanged Available
Form SFA 203 SFA Template 3 Form and Instruction Unchanged Available
Form SFA 202 SFA Template 2 Form and Instruction Unchanged Available
Form SFA 201 SFA Template 1 Form and Instruction Unchanged Available
Special Financial Assistance ICR (WDL exception) Supporting Statement.03.docx Supporting Statement A Uploaded 2023-01-26 Available
SFA FR Emergency Memo Jan 2023.02.docx Supplementary Document Uploaded 2023-01-18 Available
Assumptions Guidance, 01 FORMATTED.pdf Supplementary Document Uploaded 2022-11-28 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
254199 Lock-In Application Form and Instruction UnchangedSFA Lock-In Application
247988 Requests for determination Modified
247977 Notice of reinstatement Form and Instruction UnchangedSFA Filing Instructions, Addendum B
247976 Annual Statement of Compliance Form and Instruction UnchangedAnnual Statement of Compliance
247975 Application for Special Financial Assistance Form and Instruction UnchangedGeneral Instructions for Multiemployer Plans Applying for Special Financial Assistance
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template Checklist
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 4A
247975 Application for Special Financial Assistance Form and Instruction UnchangedModel Certification
247975 Application for Special Financial Assistance Form and Instruction UnchangedModel Plan Amendment, Reinstatement
247975 Application for Special Financial Assistance Form and Instruction UnchangedModel Plan Amendment, Compliance
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 6B
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 5B
247975 Application for Special Financial Assistance Form UnchangedPBGC E-filing Portal
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Filing Instructions, Addendum D
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Filing Instructions, Addendum C
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Filing Instructions, Addendum A
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template Checklist, Supplemented Application
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 9
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 8
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 7
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 6A
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 5A
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 4B
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 3
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 2
247975 Application for Special Financial Assistance Form and Instruction UnchangedSFA Template 1

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2023 6 Months From Approved 01/31/2026
210 0 209
879 0 871
2,130,400 0 2,105,400





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
Annual Statement of Compliance SFA 300
Application for Special Financial Assistance SFA Filing Instructions, Addendum A, SFA 202, SFA 201, SFA 203, SFA 100, SFA 204-B, SFA 205-A, SFA 206-A, SFA 207, SFA 208, SFA 209, SFA 100-Supplemented , SFA Filing Instructions, Addendum C, SFA Filing Instructions, Addendum D, PBGC E-filing Portal, SFA 204-A, SFA 205-B, SFA 206-B, Model Plan Amendment, Compliance, Model Plan Amendment, Reinstatement, Model Certification, SFA Filing Instructions ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,  
Lock-In Application SFA Lock-In Application
Notice of reinstatement SFA Filing Instructions, Addendum B
Requests for determination

table that charts list of burden
  Total Approved 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 210 209 0 1 0 0
Annual Time Burden (Hours) 879 871 0 8 0 0
Annual Cost Burden (Dollars) 2,130,400 2,105,400 0 25,000 0 0


Reginfo record details
  No