Qualified Domestic Relations Orders submitted to PBGC

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
2025 Justification Nonmaterial Change Documentation for qdrov.02.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-02-25	Repair queued
2025 Justification Nonmaterial Change Documentation for qdrov.02.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-02-25	Repair queued
2024 PBGC Supporting Statement QDRO v.5.docx	Supporting Statement A	Uploaded 2024-11-20	Repair queued
2024 PBGC Supporting Statement QDRO v.5.docx	Supporting Statement A	Uploaded 2024-11-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43802	Qualified Domestic Relations Orders submitted to PBGC	Instruction	Modified

ICR Details

OMB Control No: 1212-0054	ICR Reference No: 202502-1212-002
Status: Historical Active	Previous ICR Reference No: 202411-1212-001
Agency/Subagency: PBGC	Agency Tracking No:
Title: Qualified Domestic Relations Orders submitted to PBGC
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/28/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/26/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2028	01/31/2028	01/31/2028
Responses	253	0	253
Time Burden (Hours)	190	0	190
Cost Burden (Dollars)	177,100	0	177,100

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Abstract: PBGC is requesting an extension of approval of the information collection under its booklet, Qualified Domestic Relations Orders & PBGC. PBGC needs the information contained in qualified domestic relations orders (QDROs) in order to provide benefits to alternate payees in compliance with the requirements of Title I of ERISA. An alternate payee is required to provide this information in order to obtain benefits.

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Authorizing Statute(s): US Code: 29 USC 1056 Name of Law: ERISA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 64965	08/08/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 90320	11/15/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Qualified Domestic Relations Orders submitted to PBGC

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ICR Summary of Burden

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	253	253	0	0	0	0
Annual Time Burden (Hours)	190	190	0	0	0	0
Annual Cost Burden (Dollars)	177,100	177,100	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden decrease is attributable to a decrease in the number of domestic relations orders received by PBGC in recent years. PBGC expects to receive approximately 253 responses annually based on the number of orders received over the last three years (FY 2021-FY 2023). PBGC had anticipated receiving 428 responses.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/26/2025

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