Information Collection

Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)

IC 13583 under ICR 202602-1212-002 · OMB 1212-0049.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Appendix 1 Appendix 1 - 4010 Illustrative form Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)	Form
4010 e-Filing Portal screenshots to OMB.pdf	Other-screenshots
Final Appendix 2 - 4010 illustrative instructions to OMB.d2.pdf	Instruction
Screenshots 4010 instructions_No material changes_e-filing portal.docx	Other-Screenshots
4010 filing instructions Feb 2026 - clean.docx	Instruction
Appendix 1 Appendix 1 - 4010 Illustrative form Final Appendix 1 - 4010 illustrative form to OMB.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4010

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Appendix 1	www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Other-screenshots		www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Instruction		www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Other-Screenshots		www.pbgc.gov	Yes	Yes	Fillable Fileable Signable
Instruction			Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	9,180,000	9,180,000

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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