Information Collection

Application for Special Financial Assistance

IC 247975 under ICR 202402-1212-002 · OMB 1212-0074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0074 can be found here:

2026-05-08 - No material or nonsubstantive change to a currently approved collection
2025-03-19 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SFA 201 Application for Special Financial Assistance	Form and Instruction
sfa-filing-instructions.pdf www.pbgc.gov/sites/default/files/sfa/sfa-filing-instructions.pdf	Instruction
sfa-filing-instructions.pdf www.pbgc.gov/sites/default/files/sfa/sfa-filing-instructions.pdf	Instruction
SFA 201 SFA Template 1 Template 1 v20220701p (5).xlsx www.pbgc.gov/sites/default/files/sfa/template-1.xlsx	Form and Instruction
SFA 201 SFA Template 1 Template 1 v20220701p (5).xlsx www.pbgc.gov/sites/default/files/sfa/template-1.xlsx	Form and Instruction
SFA 202 SFA Template 2 part-4262-final-rule-template-2 .xlsx www.pbgc.gov/sites/default/files/sfa/template-2.xlsx	Form and Instruction
SFA 202 SFA Template 2 part-4262-final-rule-template-2 .xlsx www.pbgc.gov/sites/default/files/sfa/template-2.xlsx	Form and Instruction
SFA 203 SFA Template 3 Template 3.xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-3.xlsx	Form and Instruction
SFA 203 SFA Template 3 Template 3.xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-3.xlsx	Form and Instruction
SFA 204-A SFA Template 4A part-4262-final-rule-template-4a.xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4a.xlsx	Form and Instruction
SFA 204-A SFA Template 4A part-4262-final-rule-template-4a.xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4a.xlsx	Form and Instruction
SFA 204-B SFA Template 4B part-4262-final-rule-template-4b .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4b.xlsx	Form and Instruction
SFA 204-B SFA Template 4B part-4262-final-rule-template-4b .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4b.xlsx	Form and Instruction
SFA 205-A SFA Template 5A part-4262-final-rule-template-5a .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5a.xlsx	Form and Instruction
SFA 205-A SFA Template 5A part-4262-final-rule-template-5a .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5a.xlsx	Form and Instruction
SFA 205-B SFA Template 5B part-4262-final-rule-template-5b.xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5b.xlsx	Form and Instruction
SFA 205-B SFA Template 5B part-4262-final-rule-template-5b.xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5b.xlsx	Form and Instruction
SFA 206-B SFA Template 6B part-4262-final-rule-template-6b .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6b.xlsx	Form and Instruction
SFA 206-B SFA Template 6B part-4262-final-rule-template-6b .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6b.xlsx	Form and Instruction
SFA 207 SFA Template 7 part-4262-final-rule-template-7 .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-7.xlsx	Form and Instruction
SFA 207 SFA Template 7 part-4262-final-rule-template-7 .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-7.xlsx	Form and Instruction
SFA 208 SFA Template 8 part-4262-final-rule-template-8 .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-8.xlsx	Form and Instruction
SFA 208 SFA Template 8 part-4262-final-rule-template-8 .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-8.xlsx	Form and Instruction
SFA 206-A SFA Template 6A part-4262-final-rule-template-6a.xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6a.xlsx	Form and Instruction
SFA 206-A SFA Template 6A part-4262-final-rule-template-6a.xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6a.xlsx	Form and Instruction
SFA 209 SFA Template 9 part-4262-final-rule-template-9 .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-9.xlsx	Form and Instruction
SFA 209 SFA Template 9 part-4262-final-rule-template-9 .xlsx www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-9.xlsx	Form and Instruction
SFA Filing Instruc SFA Filing Instructions, Addendum A addendum-a-engaged-certain-events.pdf	Form and Instruction
SFA Filing Instruc SFA Filing Instructions, Addendum A addendum-a-engaged-certain-events.pdf	Form and Instruction
SFA Filing Instruc SFA Filing Instructions, Addendum C addendum-c-ifr-filers-supplemental-application.pdf	Form and Instruction
SFA Filing Instruc SFA Filing Instructions, Addendum C addendum-c-ifr-filers-supplemental-application.pdf	Form and Instruction
SFA Filing Instruc SFA Filing Instructions, Addendum D addendum-d-mpra-plans.pdf	Form and Instruction
SFA Filing Instruc SFA Filing Instructions, Addendum D addendum-d-mpra-plans.pdf	Form and Instruction
SFA 100 SFA Application Checklist checklist-general-sfa-application .xlsx www.pbgc.gov/sites/default/files/sfa/checklist-general-sfa-application.xlsx	Form and Instruction
SFA 100 SFA Application Checklist checklist-general-sfa-application .xlsx www.pbgc.gov/sites/default/files/sfa/checklist-general-sfa-application.xlsx	Form and Instruction
SFA 100-Supplement SFA Template Checklist, Supplemented Application checklist-supplemented-sfa-application .xlsx www.pbgc.gov/sites/default/files/sfa/checklist-supplemented-sfa-application.xlsx	Form and Instruction
SFA 100-Supplement SFA Template Checklist, Supplemented Application checklist-supplemented-sfa-application .xlsx www.pbgc.gov/sites/default/files/sfa/checklist-supplemented-sfa-application.xlsx	Form and Instruction
PBGC E-filing Port PBGC E-filing Portal SFA EFP Screenshots.docx	Form
PBGC E-filing Port PBGC E-filing Portal SFA EFP Screenshots.docx	Form
SFA Application Am SFA Application Amendment Cover Letter sfa-application-amendment-cover-letter.pdf www.pbgc.gov/documents/sfa-application-amendment-cover-letter	Form and Instruction
SFA Application Am SFA Application Amendment Cover Letter sfa-application-amendment-cover-letter.pdf www.pbgc.gov/documents/sfa-application-amendment-cover-letter	Form and Instruction
Model Plan Amendme Model Plan Amendment Compliance model-plan-amendment-compliance.docx www.pbgc.gov/sites/default/files/documents/model-plan-amendment-compliance.docx	Form and Instruction
Model Plan Amendme Model Plan Amendment Compliance model-plan-amendment-compliance.docx www.pbgc.gov/sites/default/files/documents/model-plan-amendment-compliance.docx	Form and Instruction
Model Plan Amendme Model Plan Amendment, Reinstatement model-plan-amendment-reinstatement.docx www.pbgc.gov/sites/default/files/documents/model-plan-amendment-reinstatement.docx	Form and Instruction
Model Plan Amendme Model Plan Amendment, Reinstatement model-plan-amendment-reinstatement.docx www.pbgc.gov/sites/default/files/documents/model-plan-amendment-reinstatement.docx	Form and Instruction
Model Certificatio Model Certification model-certification-plan-sponsor-reinstatement.docx www.pbgc.gov/sites/default/files/documents/model-certification-plan-sponsor-reinstatement.docx	Form and Instruction
Model Certificatio Model Certification model-certification-plan-sponsor-reinstatement.docx www.pbgc.gov/sites/default/files/documents/model-certification-plan-sponsor-reinstatement.docx	Form and Instruction
SFA Template 10 SFA Template 10 Copy of pre-2021-final-sfa-assumption-summaries-template-10.xlsx www.pbgc.gov/documents/pre-2021-zone-certification-baseline-details-and-final-sfa-assumption-summaries	Form and Instruction
SFA Template 10 SFA Template 10 Copy of pre-2021-final-sfa-assumption-summaries-template-10.xlsx www.pbgc.gov/documents/pre-2021-zone-certification-baseline-details-and-final-sfa-assumption-summaries	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Application for Special Financial Assistance

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 4262

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 and Instruction	SFA 201	SFA Template 1	Template 1 v20220701p (5).xlsx	https://www.pbgc.gov/sites/default/files/sfa/template-1.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	SFA 202	SFA Template 2	part-4262-final-rule-template-2 .xlsx	https://www.pbgc.gov/sites/default/files/sfa/template-2.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	SFA 203	SFA Template 3	Template 3.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-A	SFA Template 4A	part-4262-final-rule-template-4a.xlsx	https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4a.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	SFA 204-B	SFA Template 4B	part-4262-final-rule-template-4b .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	part-4262-final-rule-template-5a .xlsx	https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5a.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	SFA 205-B	SFA Template 5B	part-4262-final-rule-template-5b.xlsx	https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5b.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	SFA 206-B	SFA Template 6B	part-4262-final-rule-template-6b .xlsx	https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6b.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	SFA 207	SFA Template 7	part-4262-final-rule-template-7 .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	part-4262-final-rule-template-8 .xlsx	https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-8.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	SFA 206-A	SFA Template 6A	part-4262-final-rule-template-6a.xlsx	https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6a.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	SFA 209	SFA Template 9	part-4262-final-rule-template-9 .xlsx	https://www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-9.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	SFA Filing Instructions, Addendum A	SFA Filing Instructions, Addendum A	addendum-a-engaged-certain-events.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	SFA Filing Instructions, Addendum C	SFA Filing Instructions, Addendum C	addendum-c-ifr-filers-supplemental-application.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	SFA Filing Instructions, Addendum D	SFA Filing Instructions, Addendum D	addendum-d-mpra-plans.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	SFA 100	SFA Application Checklist	checklist-general-sfa-application .xlsx	https://www.pbgc.gov/sites/default/files/sfa/checklist-general-sfa-application.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	SFA 100-Supplemented	SFA Template Checklist, Supplemented Application	checklist-supplemented-sfa-application .xlsx	https://www.pbgc.gov/sites/default/files/sfa/checklist-supplemented-sfa-application.xlsx	Yes	Yes	Fillable Fileable
Form	PBGC E-filing Portal	PBGC E-filing Portal	SFA EFP Screenshots.docx		Yes	Yes	Fillable Fileable
Form and Instruction	SFA Application Amendment Cover Letter	SFA Application Amendment Cover Letter	sfa-application-amendment-cover-letter.pdf	https://www.pbgc.gov/documents/sfa-application-amendment-cover-letter	Yes	Yes	Fillable Fileable
Form and Instruction	Model Plan Amendment Compliance	Model Plan Amendment Compliance	model-plan-amendment-compliance.docx	https://www.pbgc.gov/sites/default/files/documents/model-plan-amendment-compliance.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Model Plan Amendment, Reinstatement	Model Plan Amendment, Reinstatement	model-plan-amendment-reinstatement.docx	https://www.pbgc.gov/sites/default/files/documents/model-plan-amendment-reinstatement.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Model Certification	Model Certification	model-certification-plan-sponsor-reinstatement.docx	https://www.pbgc.gov/sites/default/files/documents/model-certification-plan-sponsor-reinstatement.docx	Yes	Yes	Fillable Fileable
Instruction			sfa-filing-instructions.pdf	https://www.pbgc.gov/sites/default/files/sfa/sfa-filing-instructions.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SFA Template 10	SFA Template 10	Copy of pre-2021-final-sfa-assumption-summaries-template-10.xlsx	https://www.pbgc.gov/documents/pre-2021-zone-certification-baseline-details-and-final-sfa-assumption-summaries	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: PBGC â 19: Office of General Counsel Case Management System

FR Citation: 83 FR 6247

Number of Respondents: 45

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	45	-14	59
Annual IC Time Burden (Hours)	540	-168	708
Annual IC Cost Burden (Dollars)	1,530,000	-476,000	2,006,000

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.