Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form 5 Combined Notice of Insolvency and Notice of Insolvency Benefit Level	Form and Instruction	Modified	Available
Form Form 4 Application for Financial Assistance - Recurring	Form	Modified	Available
Form Form 3 Application for Financial Assistance - Initial	Form	Modified	Available
Form Form 2 Notice of Insolvency	Form	Modified	Available
Form Form 1 Notice of Insolvency Benefit Level	Form	Modified	Available
Form Form 1 Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Form	Modified	Repair queued
Supporting statement 0032 part 4281 2025 v3.docx	Supporting Statement A	Uploaded 2025-04-30	Available
Supporting statement 0032 part 4281 2025 v3.docx	Supporting Statement A	Uploaded 2025-04-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13552	Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Instruction	Modified
13552	Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Form and Instruction	Modified	Combined Notice of Insolvency and Notice of Insolvency Benefit Level
13552	Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Form	Modified	Application for Financial Assistance - Recurring
13552	Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Form	Modified	Application for Financial Assistance - Initial
13552	Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Form	Modified	Notice of Insolvency
13552	Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Form	Modified	Notice of Insolvency Benefit Level
13552	Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Form	Modified

ICR Details

OMB Control No: 1212-0032	ICR Reference No: 202504-1212-009
Status: Active	Previous ICR Reference No: 202205-1212-007
Agency/Subagency: PBGC	Agency Tracking No:
Title: Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/25/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/19/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2028	36 Months From Approved	06/30/2025
Responses	5,982	0	11,651
Time Burden (Hours)	113	0	241
Cost Burden (Dollars)	268,000	0	420,400

---

Abstract: Plan sponsors of multiemployer pension plans terminated by mass withdrawal give notices to PBGC and plan participants about plan insolvency and benefit reductions; notices to participants about electing benefit options; and requests to PBGC for financial assistance or permission to distributee benefits in different amounts or forms than otherwise allowed. PBGC uses information submitted to it to make statutory determinations and estimate the need for financial assistance to plans. Participants use information sent to them to make personal financial decisions.

---

Authorizing Statute(s): US Code: 29 USC 1441 Name of Law: ERISA
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 11630	03/10/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 21084	05/15/2025
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part 4281)	Form 2, Form 4, Form 1, Form 3, Form 5	Notice of Insolvency Benefit Level ,   Notice of Insolvency ,   Application for Financial Assistance - Initial ,   Application for Financial Assistance - Recurring ,   Combined Notice of Insolvency and Notice of Insolvency Benefit Level

---

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	5,982	11,651	0	-5,669	0	0
Annual Time Burden (Hours)	113	241	0	-128	0	0
Annual Cost Burden (Dollars)	268,000	420,400	0	-152,400	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The change in the estimated annual burden of this collection of information results from a decrease in the number of insolvent plans and from using an updated average number of filings actually received in the period from 2022 through 2024. PBGC estimates that the annual hour burden will decrease from 241 hours to 113 hours and the annual cost burden will decrease from $420,400 to $268,000.

---

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

---

Common Form ICR:  No

---

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: 05/19/2025

---