Locating and Paying Participants

Forms and Documents

Document Name	Status
Form MyPBA Locating and Paying Participants Form and Instruction	Modified
1212-0055 Justification of Non-Material Change.01.docx Justification for No Material/Nonsubstantive Change	2025-11-24
Acceptable_Proofs_of_Marriage.docx Supplementary Document	2025-04-10
Justification-Marriagecertificate v.02.docx Justification for No Material/Nonsubstantive Change	2025-04-10
Your Benefit Your Choice - 706V Final Ver 022023.pdf Supplementary Document	2024-05-20
Your Benefit Your Choice - 700V Final Ver 022023.pdf Supplementary Document	2024-05-20
Special Tax Notice 2024 version .pdf Supplementary Document	2024-05-20
Roth Account Special Tax Notice Final- post OGC-OPD 01032023.pdf Supplementary Document	2024-05-20
Paperwork Reduction and Privacy Act 2024 v2 FINAL.docx Supplementary Document	2024-05-20
Paperwork Reduction and Privacy Act (Hardship) 2024 v2 FINAL.docx Supplementary Document	2024-05-20
Acceptable Proofs of Age -2021.pdf Supplementary Document	2024-05-20
Supporting statement paying and locating participants 2024 v8.docx Supporting Statement A	2024-05-20

IC Document Collections

IC ID	Document Title	Status
13603	Locating and Paying Participants Form and Instruction	Modified

ICR Details

OMB Control No: 1212-0055	ICR Reference No: 202511-1212-004
Status: Received in OIRA	Previous ICR Reference No: 202504-1212-005
Agency/Subagency: PBGC	Agency Tracking No:
Title: Locating and Paying Participants
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/24/2025

	Requested	Previously Approved
Expiration Date	06/30/2027	06/30/2027
Responses	136,081	136,081
Time Burden (Hours)	101,703	101,703
Cost Burden (Dollars)	60,742	60,742

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Abstract: This collection consists of information participants and beneficiaries are asked to provide in connection with an application for benefits or request for a benefit estimate. In addition, in some instances, as part of a search for participants and beneficiaries who may be entitled to benefits, PBGC requests individuals to provide identifying information that the individual would provide as part of an initial contact with PBGC.

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Authorizing Statute(s): PL: Pub.L. 109 - 280 410 Name of Law: Pension Protection Act of 2006
   US Code: 29 USC 1322, 1350 Name of Law: Employee Retirement Security Act (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:
	89 FR 8725	02/08/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 43881	05/20/2024
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Locating and Paying Participants	Form 720CD, Form 722, 713RBD, 714RBD, 720MP Roth, 703MP Roth, Form 703RBD-MP, Form 700, Form 708, Form 710, Form 711, Form 716, Form 716A, Form 717, Form 720, Form 715, Form 720MP, Form 721, Form 721T, Form 702, Form 707, Form 705, Form 701, Form 706, Form 703MP, Form 700RN, Form 700RSC, Form 703, MyPBA, Form 703RBD, Form 703RBD-MP, Form 704, Form 712, Form 713, Form 714	MyPBA Screen Shots ,   Election of Retroactive Annuity Starting Date (Spousal Consent not Required) ,   Election of Retroactive Annuity Starting Date (Spousal Consent Required) ,   Application for Elective Lump-Sum Payment ,   Application for Elective Lump-Sum Payment ,   Application for Elective Lump-Sum Payment, post RBD ,   Report of Earnings and Social Security Disability Information ,   Uniformed Services Information Form ,   Election to Withdraw Employee Contributions ,   Withdrawal of Employee Contributions – Non-Spouse Beneficiary ,   Power of Attorney (POA) ,   Application for Lump-Sum Payment ,   Application for Eligible Rollover Payment – Non-Spouse Beneficiary ,   Payee Information Form ,   General Information Form ,   Designation of Beneficiary for Benefits Owed at Death (Currently Receiving Pension Benefits) ,   Designation of Beneficiary for Benefits Owed at Death (Not Currently Receiving Pension Benefits) ,   Application for Electronic Direct Deposit ,   Change of Beneficiary for Certain & Continuous (C&C) Benefits Only ,   Certification of Social Security Disability Status ,   Certification of Pension Plan Disability Status ,   Benefit Inquiry Questionnaire ,   Application for Lump-Sum Payment ,   Application for Lump-Sum Payment (child or dependent) ,   Financial Statement of Debtor ,   Election to Withdraw Employee Contributions, post RBD ,   Withdrawal of Employee Contributions – Non-Spouse Beneficiary ,   Application for Lump-Sum Payment Roth ,   Application for Elective Lump-Sum Payment - Roth Account ,   Participant Application for Pension Benefits ,   Beneficiary Application for Pension Benefits ,   Beneficiary Application for Pension Benefits - OF ,   Tax Election for Payment Not Eligible for Rollover ,   Application for Elective Lump-Sum Payment, post RBD ,   Application for Elective Lump-Sum Payment, post RBD (Missing Participant)

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ICR Summary of Burden

	Total Request	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	136,081	136,081	0	0	0	0
Annual Time Burden (Hours)	101,703	101,703	0	0	0	0
Annual Cost Burden (Dollars)	60,742	60,742	0	0	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: No

Burden Reduction Due to:

Short Statement:

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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: 11/24/2025

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