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