Information Collection Request

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

ICR 202504-1212-002 · OMB 1212-0049 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Appendix 1 Appendix 1 - 4010 Illustrative form Form Modified Repair queued
Form Appendix 1 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Form Modified Repair queued
4010 ICR Supporting Statement 2025.02.docx Supporting Statement A Uploaded 2025-04-08 Available
4010 ICR Supporting Statement 2025.02.docx Supporting Statement A Uploaded 2025-04-08 Repair queued
Justification Nonmaterial Change 4010 instructions.v2.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-01-16 Available
Justification Nonmaterial Change 4010 instructions.v2.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-01-16 Repair queued
Justification Nonmaterial Change 4010 instructions.v6.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-07-08 Available
Justification Nonmaterial Change 4010 instructions.v6.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-07-08 Repair queued
Justification Nonmaterial Change 4010 instructions.v1.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-01-18 Available
Justification Nonmaterial Change 4010 instructions.v1.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-01-18 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
13583 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Other-screenshots Modified
13583 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Form ModifiedAppendix 1 - 4010 Illustrative form
13583 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2026 36 Months From Approved 02/28/2026
400 0 400
800 0 800
11,080,000 0 11,080,000





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Appendix 1



Reginfo record details
  No