Information Collection

Termination of Multiemployer Plans (29 CFR Part 4041A)

IC 13529 under ICR 202504-1212-007 · OMB 1212-0020.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 001 Termination of Multiemployer Plans (29 CFR Part 4041A)	Form and Instruction
Form 001 Notice of Termination Termination of Multiemployer Plans (29 CFR Part 4041A)	Form and Instruction
Form 002 Actuarial Valuation Termination of Multiemployer Plans (29 CFR Part 4041A)	Form and Instruction
final-terminated-insolvent-reg-instructions 5-8-25.pdf efiling.pbgc.gov/	Instruction
final-terminated-insolvent-reg-instructions 5-8-25.pdf efiling.pbgc.gov/	Instruction
001 Notice of Termination Final.NOT_05082019.pdf efilingportal.pbgc.gov/site/	Form and Instruction
001 Notice of Termination Final.NOT_05082019.pdf efilingportal.pbgc.gov/site/	Form and Instruction
002 Actuarial Valuation Final.Actuarial_05082019.pdf efilingportal.pbgc.gov/site/	Form and Instruction
002 Actuarial Valuation Final.Actuarial_05082019.pdf efilingportal.pbgc.gov/site/	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4041A (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	001	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Form and Instruction	002	https://efilingportal.pbgc.gov/site/	Yes	Yes	Fillable Fileable Signable
Instruction		https://efiling.pbgc.gov/	Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 117

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	729	-88	817
Annual IC Time Burden (Hours)	32	-29	61
Annual IC Cost Burden (Dollars)	27,600	-11,800	39,400

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.

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