Administrative Appeals

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 724 Updated 6-4-25.pdf	Supplementary Document	Uploaded 2025-06-10	Available
Form 724 Updated 6-4-25.pdf	Supplementary Document	Uploaded 2025-06-10	Missing upstream
Form 723 Updated 6-10-25.pdf	Supplementary Document	Uploaded 2025-06-10	Available
Form 723 Updated 6-10-25.pdf	Supplementary Document	Uploaded 2025-06-10	Available
SS 2025 Reconsiderations v. 1.docx	Supporting Statement A	Uploaded 2025-06-04	Available
SS 2025 Reconsiderations v. 1.docx	Supporting Statement A	Uploaded 2025-06-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
46311	Administrative Appeals		Modified

ICR Details

OMB Control No: 1212-0061	ICR Reference No: 202506-1212-002
Status: Active	Previous ICR Reference No: 202211-1212-002
Agency/Subagency: PBGC	Agency Tracking No:
Title: Administrative Appeals
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: 07/21/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/16/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2028	36 Months From Approved	07/31/2025
Responses	132	0	375
Time Burden (Hours)	105	0	293
Cost Burden (Dollars)	9,000	0	37,400

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Abstract: PBGC’s regulation on Rules for Administrative Review of Agency Decisions (29 CFR part 4003) prescribes rules governing the issuance of initial determinations by PBGC and the procedures for requesting and obtaining administrative review of initial determinations. Certain types of initial determinations are subject to administrative appeals, which are covered in subpart D of the regulation. Subpart D prescribes rules on who may file appeals, when and where to file appeals, contents of appeals, and other matters relating to appeals. Under § 4003.54, an appeal must: (1) be in writing; (2) be clearly designated as an appeal; (3) specifically explain why PBGC’s determination is wrong and the result the appellant is seeking; (4) describe the relevant information the appellant believes is known by PBGC, and summarize any other information the appellant believes is relevant; (5) state whether the appellant desires to appear in person or through a representative before the Appeals Board; and (6) state whether the appellant desires to present witnesses to testify before the Appeals Board, and if so, state why the presence of witnesses will further the decision-making process. Under the regulation, where the appellant believes that another person may be aggrieved if PBGC grants the relief sought, the appeal must include the name(s) and address(es) (if known) of such other person(s).

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Authorizing Statute(s): US Code: 29 USC 1303 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:
	90 FR 15163	04/08/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 25089	06/13/2025
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
Administrative Appeals

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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	132	375	0	-243	0	0
Annual Time Burden (Hours)	105	293	0	-188	0	0
Annual Cost Burden (Dollars)	9,000	37,400	0	-28,400	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 decreases in the hour burden and cost burden are due to a decrease in the estimated number of appellants filing appeals and extension requests.

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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: 06/16/2025

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