Information Collection

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

IC 13583 under ICR 202401-1212-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form Appendix 1 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)	Form
4010 e-Filing Portal screenshots to OMB.pdf	Other-screenshots
4010 e-Filing Portal screenshots to OMB.pdf	Other-screenshots
Final Appendix 2 - 4010 illustrative instructions to OMB.d2.pdf	Instruction
Final Appendix 2 - 4010 illustrative instructions to OMB.d2.pdf	Instruction
Screenshots 4010 instructions_No material changes_e-filing portal.docx	Other-Screenshots
Screenshots 4010 instructions_No material changes_e-filing portal.docx	Other-Screenshots
Appendix 1 Appendix 1 - 4010 Illustrative form Final Appendix 1 - 4010 illustrative form to OMB.pdf	Form
Appendix 1 Appendix 1 - 4010 Illustrative form Final Appendix 1 - 4010 illustrative form to OMB.pdf	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
Other-Screenshots			Screenshots 4010 instructions_No material changes_e-filing portal.docx	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	Previously Approved
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	11,080,000	11,080,000

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.