Application for Special Financial Assistance

Special Financial Assistance by PBGC-Withdrawal Liability Condition Exception

OMB: 1212-0074

IC ID: 247975

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Application for Special Financial Assistance
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
29 CFR 4262

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SFA 201 SFA Template 1 Template 1 v20220701p.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-1.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 202 SFA Template 2 Template 2 v20220701p.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-2.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 203 SFA Template 3 Template 3 v20220701p.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-3.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 204-B SFA Template 4B Template 4B v20220701p.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4b.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 205-A SFA Template 5A Template 5A v20220701p.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5a.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 206-A SFA Template 6A Template 6A v20220701p.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6a.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 207 SFA Template 7 Template 7 v20220701p.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-7.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 208 SFA Template 8 Template 8 v20220701p.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-8.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 209 SFA Template 9 Template 9 v20220701p.xlsx https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-9.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 100-Supplemented SFA Template Checklist, Supplemented Application Application Checklist - Supplemented v20220706p.xlsx https://www.pbgc.gov/sites/default/files/sfa/checklist-supplemented-SFA-application.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA Filing Instructions, Addendum A SFA Filing Instructions, Addendum A sfa-filing-instructions-addendum-a, OMB Submission.docx https://www.pbgc.gov/sites/default/files/sfa/addendum-a-engaged-certain-events.pdf Yes Yes Fillable Fileable
Form and Instruction SFA Filing Instructions, Addendum C SFA Filing Instructions, Addendum C sfa-filing-instructions-addendum-c, OMB Submission.docx https://www.pbgc.gov/sites/default/files/sfa/addendum-c-ifr-filers-supplemental-application.pdf Yes Yes Fillable Fileable
Form and Instruction SFA Filing Instructions, Addendum D SFA Filing Instructions, Addendum D sfa-filing-instructions-addendum-d, OMB Submission.docx https://www.pbgc.gov/sites/default/files/sfa/addendum-d-mpra-plans.pdf Yes Yes Fillable Fileable
Form PBGC E-filing Portal PBGC E-filing Portal PBGC E-filing Portal Screen Shots for SFA.docx Yes Yes Fillable Fileable
Form and Instruction SFA 205-B SFA Template 5B Template 5B v20220802p.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 206-B SFA Template 6B Template 6B v20220802p.xlsx Yes Yes Fillable Fileable
Form and Instruction Model Plan Amendment, Compliance Model Plan Amendment, Compliance Model.Plan.Amendment.Under.4262.6(e)(1).Re.Compliance.pdf Yes Yes Fillable Fileable
Form and Instruction Model Plan Amendment, Reinstatement Model Plan Amendment, Reinstatement Model.Plan.Amendment.Under.4262.6(e)(2).Re.Reinstatement.pdf Yes Yes Fillable Fileable
Form and Instruction Model Certification Model Certification Model.Certification.by.Plan.Sponsor.Under.4262.7(e)(2).Re.Reinstatement.pdf Yes Yes Fillable Fileable
Form and Instruction SFA 204-A SFA Template 4A Template 4A v20221102p.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA 100 SFA Template Checklist Application Checklist v20221129p.xlsx Yes Yes Fillable Fileable
Form and Instruction SFA Filing Instructions General Instructions for Multiemployer Plans Applying for Special Financial Assistance general-sfa-application-filing-instructions-2023 renewal.05, FORMATTED.pdf Yes Yes Fillable Fileable

Income Security General Retirement and Disability

PBGC – 19: Office of General Counsel Case Management System  83 FR 6247

59 0
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 59 0 0 0 0 59
Annual IC Time Burden (Hours) 590 0 0 0 0 590
Annual IC Cost Burden (Dollars) 1,770,000 0 0 0 0 1,770,000

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