Information Collection

Pension Benefit Statement

IC 242407 under ICR 202512-1210-002 · OMB 1210-0166.

Documents and Forms

Document Name Document Type
Lifetime APPENDIX I-II-07-21-2020-clean.docx Other-Model

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pension Benefit Statement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2520.105-3

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Model			Lifetime APPENDIX I-II-07-21-2020-clean.docx		Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 801,370	Number of Respondents for Small Entity: 663,107

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 71 %

	Requested	Program Change Due to New Statute	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	478,264,514	0	30,680,447	447,584,067
Annual IC Time Burden (Hours)	162	0	0	162
Annual IC Cost Burden (Dollars)	408,370,797	41,813,023	-104,679,901	471,237,675

Documents for IC

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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