Information Collection Request

Special Financial Assistance by PBGC

ICR 202310-1212-005 · OMB 1212-0074 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SFA Lock-In Applic Lock-In Application Form and Instruction Unchanged Available
Form SFA Filing Instruc Notice of reinstatement Form and Instruction Unchanged Available
Form SFA 300 Annual Statement of Compliance Form and Instruction Unchanged Available
Form SFA 201 Application for Special Financial Assistance Form and Instruction Modified Available
sfa-assumptions-guidance October 2023_final.pdf Supplementary Document Uploaded 2023-11-01 Available
SFA FR Emergency Memo Census Data October 2023.10.docx Supplementary Document Uploaded 2023-10-30 Available
Special Financial Assistance ICR (October 2023 Emergency Request) Supporting Statement.06.docx Supporting Statement A Uploaded 2023-10-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
254199 Lock-In Application Form and Instruction Unchanged
247988 Requests for determination Unchanged
247977 Notice of reinstatement Form and Instruction Unchanged
247976 Annual Statement of Compliance Form and Instruction Unchanged
247975 Application for Special Financial Assistance Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2024 6 Months From Approved 07/31/2026
210 0 210
997 0 938
2,366,400 0 2,248,400





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table that charts list of burden
IC Title Form No. Form Name
Annual Statement of Compliance SFA 300 Annual Statement of Compliance
Application for Special Financial Assistance SFA Application Amendment Cover Letter, SFA Filing Instructions, Addendum A, SFA 202, SFA 201, 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 203, SFA 100, SFA 210 SFA Template 1 ,   SFA Template 2 ,   SFA Template 4B ,   SFA Template 5A ,   SFA Template 6A ,   SFA Template 7 ,   SFA Template 8 ,   SFA Template 9 ,   SFA Template Checklist, Supplemented Application ,   SFA Filing Instructions, Addendum A ,   SFA Filing Instructions, Addendum C ,   SFA Filing Instructions, Addendum D ,   PBGC E-filing Portal ,   SFA Template 5B ,   SFA Template 6B ,   Model Plan Amendment, Compliance ,   Model Plan Amendment, Reinstatement ,   Model Certification ,   SFA Template 4A ,   SFA Template 3 ,   SFA Application Checklist ,   SFA Template 10 ,   SFA Application Amendment Cover Letter
Lock-In Application SFA Lock-In Application SFA Lock-In Application
Notice of reinstatement SFA Filing Instructions, Addendum B 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 210 210 0 0 0 0
Annual Time Burden (Hours) 997 938 0 59 0 0
Annual Cost Burden (Dollars) 2,366,400 2,248,400 0 118,000 0 0


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