2024 Form 200 Instructions

Form 200 Instructions
NOTICE OF FAILURE TO MAKE REQUIRED
CONTRIBUTIONS
The Form 200 is used to notify the Pension Benefit Guaranty Corporation of a failure to make required
contributions to a single-employer plan that is covered under ERISA section 4021 and whose FTAP is less than
100% if the total of unpaid balances, including interest, exceeds $1 million (see ERISA section 303(k)(4)(A)
and Code section 430(k)(4)(A)). For questions, contact (202) 229-4070 or [email protected].

Table of Contents

Page

Introduction

2

General Instructions

4

Definitions

6

Specific Instructions

6

General Plan Information

6

Plan Funding Information

7

Additional Information to be Filed

7

Actuarial Information

8

Certifications

9

Appendix – Example of Calculation Concerning Failure to Make Required Funding Payments

A-1

Form 200 Instructions
and-several liability of each controlled group
member for required payments (whether the
controlled group of which a contributing
sponsor is a member is a “parent-subsidiary,”
“brother-sister,” or “combined” group),
the imposition of the lien on all assets of
each controlled group member, or the ability
of PBGC to take all appropriate steps to
perfect and enforce the lien.

INTRODUCTION
ERISA §303(k) and Code §430(k) provide that a
lien arises in certain cases where there is a failure
to make required contributions to a singleemployer plan covered under ERISA §4021 whose
funding target attainment percentage (as defined in
ERISA §303(d) and Code §430(d)(2)) is less than
100 percent. The lien arises, in favor of the plan,
upon all property and rights to property (whether
real or personal) belonging to the person or persons
who are liable for required contributions (i.e., a
contributing sponsor and each member of the
controlled group of which that contributing sponsor
is a member) if:

PBGC has restricted Form 200 to information
generally needed in its decision-making
regarding enforcement of a lien imposed by
ERISA §303(k) and Code §430(k). If PBGC
concludes that it needs additional information
in a particular case, it will notify (in writing) the
person required to supplement the Form 200
and specify the date by which the additional
information must be submitted.

1. any person fails to make a required
contribution payment when due, and
2. the unpaid balance of the payment (including
interest), when added to the aggregate unpaid
balance of all preceding such payments for
which payment was not made when due
(including interest), exceeds $1 million.

What’s New
The Form 200 instructions and Form 200 have
been changed as follows:
• Added the amount of required payment
that resulted in the requirement to notify
PBGC (this is in addition to the already
required due date of required payment that
resulted in the requirement to notify
PBGC).
• PBGC no longer accepts electronic
filing by email as of October 1, 2021.
PBGC’s e-filing portal, available for
reportable events filings since 2016,
offers a secure application for
submitting Form 200 information. The
e-filing portal allows filers to:

Any lien imposed for failure to make required
contributions may be perfected and enforced only
by PBGC or, at its direction, by the plan’s
contributing sponsor or any member of the
contributing sponsor’s controlled group. ERISA
§303(k)(4)(A) and Code §430(k)(4)(A) require that
PBGC be notified whenever there is a failure to
make a required payment and the total of unpaid
balances (including interest) exceeds $1 million.
Notice must be provided within 10 days of the due
date for the required payment.
To comply with this notification requirement,
PBGC regulations (29 CFR 4043.81) require that a
contributing sponsor and, if that contributing
sponsor is a member of a parent-subsidiary
controlled group, the “ultimate parent,” file Form
200 whenever such a failure occurs.

− Review filings and generate a list

−
−
−

Note: PBGC’s decision not to require (at this time)
controlled
group
members
other
than
contributing sponsors and ultimate parents to file
Form 200 does not in any way limit the joint-

−
−
2

of omissions and inconsistencies
prior to submission to ensure that
filings are complete.
Save a partially completed filing.
Modify information any time prior to
submission.
Pre-populate a filing with data from a
previously submitted filing.
Route the filing as needed to facilitate ecertifications.
Review prior filings submitted via the efiling portal.

Form 200 Instructions
The portal can be accessed using the following
address: efilingportal.pbgc.gov.
Notification of future changes to any forms and
instructions may be found under “What’s
New” on the Employers & Practitioners page
at www.pbgc.gov/whatsnew.

3

Form 200 Instructions
GENERAL INSTRUCTIONS

Attaching files

Who Must File

Filers may attach electronic files to their submission.
Examples of files that may be attached include, but
are not limited to, actuarial valuation reports,
financial statements, and organizational charts.

Form 200 must be filed by (1) a contributing
sponsor and (2) if a contributing sponsor is a
member of a “parent-subsidiary” controlled
group, the ultimate parent of such group.
However, if a timely and complete Form 200 is
properly filed by either a contributing sponsor or
the ultimate parent, PBGC will deem the other to
have so filed. (As noted in the “Introduction,”
each other member of any controlled group of
which a contributing sponsor is a member also is
jointly and severally liable for required
payments, and PBGC may enforce the statutory
lien imposed on its assets.)

If you are filing materials electronically that are
larger than 10 megabytes, please use Leap-FILE.
First send an email to [email protected] to request
a recipient email address. The email address provided
will be that of a PBGC staff member, e.g., a “[last
name].[first name]@pbgc.gov” email address. Enter
“pbgc.leapfile.com” in your Internet browser, click
on “secure upload,” enter the email address provided
by PBGC in the “Recipient Email” field, and attach
the files.
When to File

Note: An authorized representative may file a
Form 200 on behalf of a contributing sponsor, a
parent, or both.

Form 200, including all required documentation and
information, must be filed with PBGC no later than
10 days after the due date for the required payment.

Special Rule for Terminating Plans: The fact that
a plan is in the process of terminating does not
mean that a Form 200 notice need not be filed.
However, a notice is waived if the deadline for
filing the notice is on or after the date on which
(1) all of the plan’s assets (other than any
excess assets) are distributed pursuant to a
termination or (2) a trustee is appointed for
the plan under ERISA § 4042(c).

Note: Form 200 must be filed each time there is a
failure described in ERISA § 303(k)(1) and Code
§ 430(k)(1) and the total of unpaid balances of
required payments (including interest) exceeds $1
million.
Notice Filing Date

How to File
must
be
prepared
Forms
electronically using the 4043
PBGC’s e-filing portal. To
exemption from e-filing, send a
email to [email protected].

The date a Form 200 is considered to have been filed
is the date received through PBGC’s e-filing portal.
See 29 CFR § 4000.29.

and
filed
module of
request an
request via

Computation of time: In computing the 10-day
period, the due date of the payment that resulted in
the requirement to notify PBGC is not included.
Form 200 is due 10 days thereafter unless that
day is a Saturday, Sunday, or Federal holiday, in
which case the 10-day period runs until the next day
that is not a Saturday, Sunday, or Federal holiday.
Information received on a weekend or Federal holiday
or after 5:00 p.m. on a weekday is considered filed
on the next regular business day.
4

Form 200 Instructions

What to File

For Questions or Problems Regarding Form
200

A contributing sponsor must use the PBGC Form 200
to file a notice of a failure to make required
contributions. Certain individual items on the form
call for additional information.

If you have questions or problems regarding Form
200 or these instructions, contact:
Pension Benefit Guaranty Corporation
Corporate Finance and Restructuring Department
445 12th Street SW, Washington DC 20024-2101
Telephone: 202-229-4070
Email: [email protected]

Attachments
If responding to an item requires the attachment of
documentation or information, mark the attachment
to identify the item to which it responds.

If you are having problems using the e-filing portal,
contact PBGC at [email protected].

Previously Submitted Information
Because ERISA §303(k)(4)(A) and Code
§430(k)(4)(A) require that PBGC be notified each
time there is a failure to make a required payment and
the total of unpaid balances of required payments
(including interest) exceeds $1 million, more than
one filing may be required regarding the same plan,
and at least some of the information included in a
previous Form 200 filing may continue to be accurate
and responsive at the time that a subsequent Form
200 must be filed. It also is possible that information
submitted to PBGC in another context (e.g., in a
distress termination filing pursuant to ERISA
§4041(c) or in a notice of a reportable event required
by 29 CFR Part 4043) is responsive. A filer may
respond to an item that calls for previously submitted
documentation or other information by identifying
the previous submission in which the response was
provided.

If you are deaf, hard of hearing, or have a speech
disability,
please
dial
7-1-1
to
access
telecommunications relay services.
Copies of Form 200 and instructions may be
obtained from PBGC’s website at http://
www.pbgc.gov/prac/ forms.
Reportable Event
A failure to make a required contribution may also
be a reportable event under 29 CFR 4043.25(a). If
with respect to such failure, a Form 200 is
completed and submitted in accordance with 29
CFR 4043.81, the Form 200 filing is deemed
to satisfy the reportable event requirement
(see 29 CFR 4043.25(b)).
Note: If a contributing sponsor or controlled group
member files a complete Form 200 with PBGC
within 10 days of the due date of the payment in
accordance with 29 CFR §4043.81, the Form 200
filing satisfies the notice requirement for purposes of
29 CFR 4043.25(a). However, Form 10 may also be
filed if desired. Choosing to rely on Form 200 to
satisfy the Form 10 filing requirement does not make
the Form 200 a reportable event filing under ERISA
§4043 and does not give the Form 200 filing the
benefit of the confidentiality protection for
reportable event notices under ERISA §4043(f).

Effect of Failure to Timely File
If a Form 200 (or other required information) is not
provided within the specified time limit, PBGC may
assess a penalty under ERISA §4071 against each
person required to provide the Form 200 (see 29 CFR
Part 4071 and PBGC’s Statement of Policy on
Assessment of Penalties for Failure to Provide
Required Information (60 FR 36837, July 18, 1995)).
PBGC may pursue any other equitable or legal
remedies available to it under the law.
5

Form 200 Instructions

Required installment means any of the four
quarterly contribution payments required for each
plan year by ERISA §303(j) and Code §430(j).

DEFINITIONS
As used in PBGC Form 200 and these instructions:
Code means the Internal Revenue Code of 1986, as
amended.

Required payment means a required installment or
other payment required under ERISA §§ 302 and 303
and Code §§ 412 and 430 or as a result of a funding
waiver.

Contributing sponsor means a person that is a
contributing sponsor as defined in ERISA §4001(a)
(13).

Single-employer plan means any defined benefit
plan (as defined in ERISA §3(35)) that is not a
multiemployer plan (as defined in ERISA
§4001(a) (3)) and that is covered by title IV of
ERISA.

Controlled group, for purposes of ERISA §303(k)
and Code §430(k), means any group treated as a
single employer under subsection (b), (c), (m), or
(o) of Code §414.

Ultimate Parent means the parent at the highest
level in the chain of corporation and/or other
organizations constituting a parent-subsidiary
controlled group. (For example, if Corporation A
owns all of the stock of Corporation B and
Corporation C, and Corporation B owns all of the
stock of Corporation X, the contributing sponsor,
then the “ultimate parent” of Corporation X is
Corporation A.)

Due date means the date set forth in ERISA §303(j)
and Code §430(j) for payment of a required
installment and, in the case of a payment other than a
required installment, the date such payment is
required to be made under ERISA §303 and Code
§430.
EIN/PN
means
the
nine-digit
employer
identification number assigned by the Internal
Revenue Service to a person and the three-digit plan
number assigned to a plan. The EIN/PN should be
the EIN/PN most recently reported for a PBGC
premium filing (if applicable).

SPECIFIC INSTRUCTIONS
General Plan Information
• Complete name of the plan as it appears on the
plan document and the plan year commencement
date

ERISA means the Employee Retirement Income
Security Act of 1974, as amended.

•

The EIN/PN reported should be the EIN/PN most
recently reported for a PBGC premium filing (if
applicable). If the plan has never made a PBGC
premium filing, enter the EIN assigned to the
contributing sponsor by the IRS for income tax
purposes and the PN assigned by the contributing
sponsor.

•

Name, address, telephone number, and email
address of the individual or the board or other
entity, if any, specifically designated as plan
administrator by the terms of the plan or trust
agreement. If none is so designated, enter the
name, address, telephone number, and email
address of the contributing sponsor.

IRS means the Internal Revenue Service.
Notice due date means the deadline for filing a Form
200 with PBGC.
Notice Filing Date means the date the Form 200
is received by PBGC.
Person means an individual, partnership, joint
venture, corporation, mutual company, joint-stock
company, trust, estate, unincorporated organization,
association, or employee organization.
6

Form 200 Instructions

•

The name, title, e-mail address, and phone
number of an individual whom PBGC should
contact if it has questions about the filing.

Plan Funding Information
Note: An enrolled actuary must certify that the
information in this section is true, correct, and
complete, and conforms to applicable regulatory
requirements (see Certification section).
•
•

Due date of required payment.
Amount of the required payment.

•

The total amount, as of the due date, of the
unpaid balance of the required payment and the
aggregate unpaid balance of all preceding
required payments for which payment was not
made when due (i.e., include in this amount the
unpaid balances, including interest, of all
required payments for which payment was not
made when due). See Appendix for an example
of how to compute the total amount.

•

Description of how the unpaid balance of
required payments was determined. This
description must include an attached spreadsheet
that shows the details of the calculation (see
Appendix for an example of how the required
information may be shown).

Additional Information to be Filed
Additional information to be filed (check all boxes
for information attached to form; see below for
description of Actuarial Information required).
•

Description of the plan’s controlled group
structure (including the contributing sponsor and
the ultimate parent of the controlled group),
including the name, address, telephone number,
and EIN of each controlled group member

•

Location of real property owned by each
controlled group member

•

Name and address of the controlled group’s
principal executive office

•

Operational status of each controlled group
member (in Chapter 7 proceedings, liquidating
outside of bankruptcy, in Chapter 11
proceedings, on-going, etc.)

•

Name, address, telephone number and EIN of

•

each contributing sponsor of the plan

•

Reason contribution was not made by due date

•

Copy of any IRS letter(s) granting or modifying
a funding waiver and/or extension of the
amortization period

•

Statement describing any pending request(s) for
a funding waiver and/or extension of the
amortization period

•

Copies of audited financial statements (if
available) or (if not) unaudited financial
statements that were prepared for the
contributing sponsor and each other controlled
group member individually, including balance
sheets, income statements, statements of cash
flows,

•

and notes to financial statements and annual
reports. However, if financial statements were
only prepared on a consolidated basis for more
than one controlled group member, consolidated
financial statements and consolidating financial
statements (if available) and (if not)
consolidating trial balances that identify each
controlled group member individually may be
attached instead. Copies of financial statements
for the most recent three fiscal years available,
and the most recent available interim financial
statement, for each member of the plan’s
controlled group, including the contributing
sponsor and the ultimate parent

Also include an explanation of any information
required to be filed but missing from the filing.

7

Note – Simplified Reporting: Most “Additional
Information to be Filed” does not need to be
submitted if the filer has not missed any required
contribution (other than the missed contribution that
triggered the Form 200 filing requirement) during

Form 200 Instructions
the two-year period ending on the notice due date for
the Form 200 and has made up the missed
contribution by the notice due date. The only
additional information required is the reason the
contribution was not made by the due date. PBGC
may also request evidence that the contribution has
been made. The filer should note Simplified
Reporting is being used in the missing information
section of the filing.

430(h)(2)(A));

Actuarial Information
Please include the following for each plan
maintained by any member of the plan’s controlled
group:
•

Copy of the most recent Actuarial Valuation
Report that includes or is supplemented with all
of the items described below. If the amount of the
most recent missed contribution is based on a
calculation that is not reflected in the most recent
Actuarial Valuation Report, also provide all of
the information described below that supports the
calculation:
–

The funding target calculated pursuant to
ERISA section 303 without regard to
subsection 303(i)(1), setting forth separately
the value of the liabilities attributable to
retirees and beneficiaries receiving payment,
terminated vested participants, and active
participants (showing vested and non-vested
benefits separately;

–

A summary of the actuarial assumptions and
methods used for purposes of ERISA section
303 and any changes in those assumptions
and methods since the previous valuation and
justifications for any change; in the case of a
plan that provides lump sums, other than de
minimis lump sums, the summary must
include the assumptions on which
participants are assumed to elect a lump sum
and how lump sums are valued;

–

The effective interest rate (as defined in ERISA section 303(h)(2)(A) and Code section

8

–

The target normal cost calculated pursuant to
ERISA section 303 without regard to
subsection 303(i)(2) (and Code section 430
without regard to subsection 430(i)(2));

–

For the plan year and the four preceding
plan years, a statement as to whether the
plan was in at-risk status for that plan year;

–

In the case of a plan that is in at-risk status,
the target normal cost calculated pursuant
to ERISA section 303 as if the plan has
been in at-risk status for 5 consecutive
years;

–

The value of the plan’s assets (reflecting any
averaging method) as of the valuation date
and the fair market value of the plan’s
assets as of the valuation date;

–

The funding standard carryover balance and
the prefunding balance (maintained
pursuant to ERISA section 303(f)(1) and
Code section 430(f)(1)) as of the
beginning of the plan year and a summary of
any changes in such balances in the past
year (e.g., amounts used to off- set
minimum funding requirement, amounts
reduced in accordance with any elections under ERISA section 303(f)(5) or Code section
430(f)(5), interest credited to such balances,
and excess contributions used to increase
such balances);

–

A list of amortization bases (shortfall and
waiver) under ERISA section 303 and
Code section 430, including the year
the base was established, the original
amount,
the
installment amount, and
the remaining balance at the beginning of
the plan year;

–

An age/service scatter for active
participants
including
average
compensation information for payrelated plans and average account

Form 200 Instructions

balance information for hybrid plans
presented in a format similar to that
described in the instructions to Schedule SB of
the Form 5500;
–

Expected
disbursements
(benefit
payments and expenses) during the plan year;
and

–

A summary of the principal eligibility and
benefit provisions on which the valuation
of the plan was based (and any changes to
those provisions since the previous
valuation), along with descriptions
of any benefits not included in the
valuation, any significant events that
occurred during the plan year, and the
plan’s early retirement factors; in the case of a
plan that provides lump sums, other than de
minimis lump sums, the summary must
include information on how annuity
benefits are converted to lump sum
amounts (for example, whether early
retirement subsidies are reflected).

•

Statement of any material change in liabilities
of the plan occurring after the date of the
most recent Actuarial Valuation Report.

•

Most recent month-end market value of
plan assets.

•

Contact name, telephone number, and
employer of the plan actuary if different from
that listed on the most recently filed
Schedule SB to Form 5500.

•

Copies of election letters relating to
the application of carryover or prefunding
balances to the contributions.

Certification must be made by an officer (or an
individual of comparable authority in an
unincorporated organization) of the contributing
sponsor or ultimate parent that is filing the Form
200.

Certifications
Plan funding information and related explanation
certification must be made by an enrolled actuary
Contributing Sponsor or Parent

9

Form 200 Instructions
APPENDIX
Example on How to Describe the Aggregate Unpaid Balance of Required Funding Payments
Assume the plan sponsor of a calendar-year plan:
•

missed a required 2017 quarterly installment of $600,000 on January 15, 2018

•

made a contribution of $200,000 on March 1, 2018

•

missed a 2018 required quarterly installment of $500,000 on April 15, 2018

•

missed a 2018 required quarterly installment of $500,000 on July 15, 2018

•

missed the final 2017 required contribution of $150,000 on September 15, 2018

In addition, assume the effective interest rate for plan year 2017 was 8% and for plan year 2018 was 6%. Adding
5% (see ERISA §303(j)(3)(A)) to the effective interest rates for the periods of underpayment, the applicable interest
rates for the missed quarterlies for the 2017 and 2018 plan years are 13% and 11%, respectively.
Aggregate Unpaid Balance of Required Contributions as of 7/15/2018
Date

Contribution
Type

Applicable Plan
Year

Applicable Interest
Rate

Amount

Days until
07/15/2018

Interest
Adjustment

Total

01/15/2018/Quarterly

Missed

2017

13%

$600,000

181

$37,488

$637,488

03/01/2018/Quarterly

Paid

2017

13%

-$200,000

136

-$9,318

-$209,318

04/15/2018/Quarterly

Missed

2018

11%

$500,000

91

$13,180

$513,180

07/15/2018/Quarterly

Missed

2018

11%

$500,000

0

$0

$500,000

$41,350

$1,441,350

Total

$1,400,000

Because the aggregate unpaid balance of required payments as of July 15, 2018 ($1,441,350) exceeds $1,000,000, a
Form 200 filing is due on July 25, 2018 (10 days after the missed contribution, with weekend extension). The table
shown above is an example of the data to be submitted with the Form 200 filing.
Aggregate Unpaid Balance of Required Contributions as of 9/15/2018
Date

Contribution
Type

Applicable Plan
Year

Applicable Interest
Rate

Amount

Days until
07/15/2018

Interest
Adjustment

Total

01/15/2018/Quarterly

Missed

2017

13%

$600,000

243

$50,861

$650,861

03/01/2018/Quarterly

Paid

2017

13%

-$200,000

198

-$13,709

-$213,709

04/15/2018/Quarterly

Missed

2018

11%

$500,000

153

$22,358

$522,358

07/15/2018/Quarterly

Missed

2018

11%

$500,000

62

$8,942

$508,942

09/15/2018/Final

Missed

2017

8%

$150,000

0

$0

$150,000

$68,452

$1,618,452

Total

$1,550,000

Because the aggregate unpaid balance of required payments as of September 15, 2018 ($1,618,452) exceeds
$1,000,000, an updated Form 200 filing is due on September 25, 2018 (10 days after the missed contribution, with
weekend extension). The table shown above is an example of the data to be submitted with the Form 200 filing.

A-1

Form 200 Instructions

PAPERWORK REDUCTION ACT NOTICE
PBGC needs this information, which is required to be filed under section 303(k)(4) of ERISA and section
430(k)(4) of the Internal Revenue Code (the Code) and 29 CFR Part 4043, Subparts A and D, to make decisions
regarding enforcement of a lien imposed by section 303(k)(1) of ERISA and section 430(k)(1) of the Code.
Information provided to PBGC is confidential to the extent provided in the Freedom of Information Act and
the Privacy Act.
PBGC estimates that it will take an average of 1 hour and $725 to comply with the requirements described in
these instructions. These figures are estimated averages that will vary depending on the nature and
organizational structure of persons liable for plan contributions (in particular, whether the plan’s contributing
sponsor is a member of a controlled group and, if so, the size of that group) and on the funding history of the
plan.
If you have any comments concerning the accuracy of these time estimates or suggestions for improving the
form or these instructions, please send your comments to the Pension Benefit Guaranty Corporation, Regulatory Affairs Group, Office of the General Counsel, 445 12th Street SW, Washington, DC 20024-2101.
This collection of information has been approved by the Office of Management and Budget (OMB) under
control number 1212-0041. An agency may not conduct or sponsor, and a person is not required to respond
to, a collection of information unless it displays a currently valid OMB.