Notice of Failure to Make Required Contributions

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0041 can be found here:

Documents and Forms

Document Name Document Type
Form Form 200 Notice of Failure to Make Required Contributions Form
4043 screenshots_Revised April 2021_Form 200.docx Other-Screen shots
4043 screenshots_Revised April 2021_Form 200.docx Other-Screen shots
Form-200-Instructions, October 2023 edits.pdf Instruction
Form-200-Instructions, October 2023 edits.pdf Instruction
Form 200 Notice of Failure to Make Required Contributions Form 200_Revised_Clean.docx Form
Form 200 Notice of Failure to Make Required Contributions Form 200_Revised_Clean.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice of Failure to Make Required Contributions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4043

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form 200	Notice of Failure to Make Required Contributions	Form 200_Revised_Clean.docx		Yes	Yes	Fillable Fileable Signable
Instruction			Form-200-Instructions, October 2023 edits.pdf		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: 88	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	88	88
Annual IC Time Burden (Hours)	88	88
Annual IC Cost Burden (Dollars)	63,800	63,800

Documents for IC

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.