OMB control number

Special Financial Assistance by PBGC

OMB 1212-0074 · PBGC.

OMB 1212-0074

Under section 4262 of the Employee Retirement Income Security Act of 1974 (ERISA) PBGC administers a Special Financial Assistance program for financially troubled multiemployer plans. The statute sets forth the requirements for this program, including specifying which plans are eligible to apply, the cutoff date for applications, actuarial assumptions, determinations on applications, restrictions and conditions on plans that receive SFA, and the requirements for certain plans with suspended benefits to reinstate those benefits and provide make-up payments to restore previously suspended benefits. Unlike financial assistance under section 4261 of ERISA, which is provided in the form of a loan and in periodic payments, a plan receiving SFA under section 4262 has no obligation to repay SFA. This information collection contains the requirements necessary to implement the SFA program and to provide proper stewardship of taxpayer funds. These information requirements include: • An application for SFA (including calculating the amount of SFA) that the plan sponsor of an eligible multiemployer plan must file with PBGC to receive payment of SFA. PBGC needs the information in the application to review a plan’s eligibility for SFA, priority group status (if applicable), and amount of requested SFA. • A lock-in application that plan may, but is not required, to use to lock in its base data. PBGC needs the information in the lock-in application to garner a plan's base data when the plan files a full application for SFA> • An Annual Statement of Compliance (with the restrictions and conditions under section 4262 of ERISA and 29 CFR part 4262) that a plan that has received SFA is required to file with PBGC. PBGC needs the information in the Annual Statement of Compliance to ensure that a plan is compliant with the imposed restrictions and conditions. • A notice of reinstatement that a plan sponsor of a plan with benefits that were suspended under sections 305(e)(9) or 4245(a) of ERISA must issue to participants and beneficiaries whose benefits are reinstated. Participants and beneficiaries need the notice of reinstatement to better understand the calculation and timing of their reinstated benefits and, if applicable, make-up payments. • A request for a determination from PBGC for approval for an exception under certain circumstances for SFA conditions under § 4262.16 relating to reductions in contributions, transfers or mergers, benefit increases, and settlement of withdrawal liability. PBGC needs the information required for a request for determination to determine whether to approve an exception from the specified condition.

The latest form for Special Financial Assistance by PBGC expires 2027-05-31 and is listed under ICR 202605-1212-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form Lock-in Applicatio Lock-in ApplicationForm and Instruction
Form Lock-in Applicatio Lock-in ApplicationForm and Instruction
Form SFA Filing Instruc SFA Filing Instructions, Addendum BForm and Instruction
Form SFA Filing Instruc SFA Filing Instructions, Addendum BForm and Instruction
Form SFA 300 Annual Statement of ComplianceForm and Instruction
Form SFA 300 Annual Statement of ComplianceForm and Instruction
Form SFA 100 SFA Application ChecklistForm and Instruction
Form SFA 100 SFA Application ChecklistForm and Instruction
Form SFA Template 10 SFA Template 10Form and Instruction
Form SFA Template 10 SFA Template 10Form and Instruction
Form Model Certificatio Model CertificationForm and Instruction
Form Model Certificatio Model CertificationForm and Instruction
Form Model Plan Amendme Model Plan Amendment, ReinstatementForm and Instruction
Form Model Plan Amendme Model Plan Amendment, ReinstatementForm and Instruction
Form Model Plan Amendme Model Plan Amendment ComplianceForm and Instruction
Form Model Plan Amendme Model Plan Amendment ComplianceForm and Instruction
Form SFA Application Am SFA Application Amendment Cover LetterForm and Instruction
Form SFA Application Am SFA Application Amendment Cover LetterForm and Instruction
Form PBGC E-filing Port PBGC E-filing PortalForm
Form PBGC E-filing Port PBGC E-filing PortalForm
Form SFA 100-Supplement SFA Template Checklist, Supplemented ApplicationForm and Instruction
Form SFA 100-Supplement SFA Template Checklist, Supplemented ApplicationForm and Instruction
Form SFA Filing Instruc SFA Filing Instructions, Addendum DForm and Instruction
Form SFA Filing Instruc SFA Filing Instructions, Addendum DForm and Instruction
Form SFA Filing Instruc SFA Filing Instructions, Addendum CForm and Instruction
Form SFA Filing Instruc SFA Filing Instructions, Addendum CForm and Instruction
Form SFA Filing Instruc SFA Filing Instructions, Addendum AForm and Instruction
Form SFA Filing Instruc SFA Filing Instructions, Addendum AForm and Instruction
Form SFA 209 SFA Template 9Form and Instruction
Form SFA 209 SFA Template 9Form and Instruction
Form SFA 206-A SFA Template 6AForm and Instruction
Form SFA 206-A SFA Template 6AForm and Instruction
Form SFA 208 SFA Template 8Form and Instruction
Form SFA 208 SFA Template 8Form and Instruction
Form SFA 207 SFA Template 7Form and Instruction
Form SFA 207 SFA Template 7Form and Instruction
Form SFA 206-B SFA Template 6BForm and Instruction
Form SFA 206-B SFA Template 6BForm and Instruction
Form SFA 205-B SFA Template 5BForm and Instruction
Form SFA 205-B SFA Template 5BForm and Instruction
Form SFA 205-A SFA Template 5AForm and Instruction
Form SFA 205-A SFA Template 5AForm and Instruction
Form SFA 204-B SFA Template 4BForm and Instruction
Form SFA 204-B SFA Template 4BForm and Instruction
Form SFA 204-A SFA Template 4AForm and Instruction
Form SFA 204-A SFA Template 4AForm and Instruction
Form SFA 203 SFA Template 3Form and Instruction
Form SFA 203 SFA Template 3Form and Instruction
Form SFA 202 SFA Template 2Form and Instruction
Form SFA 202 SFA Template 2Form and Instruction
Form SFA 201 SFA Template 1Form and Instruction
Form SFA 201 SFA Template 1Form and Instruction
SFA Merger WDL Illustrative Calculations-2026.02.05_To_OGC.xlsxSupplementary Document
SFA Merger WDL Illustrative Calculations-2026.02.05_To_OGC.xlsxSupplementary Document
Justification Nonmaterial Change_1212-0074 Mergers Amendment and FAQs 5.05.26 CLEAN ltt.docxJustification for No Material/Nonsubstantive Change
Justification Nonmaterial Change_1212-0074 Mergers Amendment and FAQs 5.05.26 CLEAN ltt.docxJustification for No Material/Nonsubstantive Change
Justification Nonmaterial Change-amendment cover letter v01.docxJustification for No Material/Nonsubstantive Change
Justification Nonmaterial Change-amendment cover letter v01.docxJustification for No Material/Nonsubstantive Change
Justification Nonmaterial Change - Checklist.02.docxJustification for No Material/Nonsubstantive Change
Justification Nonmaterial Change - Checklist.02.docxJustification for No Material/Nonsubstantive Change
sfa-assumptions-guidance.pdfSupplementary Document
sfa-assumptions-guidance.pdfSupplementary Document
Special Financial Assistance ICR (May 2024 Renewal) Supporting Statement.03.docxSupporting Statement A
Special Financial Assistance ICR (May 2024 Renewal) Supporting Statement.03.docxSupporting Statement A
Lock-In Application Form and Instruction
Lock-In Application Form and Instruction
Requests for determination Information collection
Notice of reinstatement Form and Instruction
Notice of reinstatement Form and Instruction
Annual Statement of Compliance Form and Instruction
Annual Statement of Compliance Form and Instruction
Annual Statement of Compliance Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form
Application for Special Financial Assistance Form
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Form and Instruction
Application for Special Financial Assistance Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202605-1212-001 No material or nonsubstantive change to a currently approved collection 2026-05-08
202503-1212-001 No material or nonsubstantive change to a currently approved collection 2025-03-19 Approved without change
202407-1212-001 No material or nonsubstantive change to a currently approved collection 2024-07-03 Approved without change
202402-1212-002 Revision of a currently approved collection 2024-03-28 Approved without change
202310-1212-005 Revision of a currently approved collection 2023-11-01 Approved without change
202309-1212-001 No material or nonsubstantive change to a currently approved collection 2023-09-25 Approved with change
202305-1212-002 Revision of a currently approved collection 2023-06-02 Approved with change
202303-1212-001 No material or nonsubstantive change to a currently approved collection 2023-03-07 Approved without change
202301-1212-002 Revision of a currently approved collection 2023-01-26 Approved without change
202211-1212-003 Revision of a currently approved collection 2022-11-29 Approved without change
202210-1212-001 No material or nonsubstantive change to a currently approved collection 2022-10-24 Approved without change
202208-1212-002 No material or nonsubstantive change to a currently approved collection 2022-08-10 Approved without change
202208-1212-001 No material or nonsubstantive change to a currently approved collection 2022-08-03 Approved without change
202205-1212-008 Revision of a currently approved collection 2022-07-08 Approved without change
202112-1212-003 Extension without change of a currently approved collection 2021-12-08 Approved with change
202112-1212-002 No material or nonsubstantive change to a currently approved collection 2021-12-03 Approved without change
202106-1212-004 New collection (Request for a new OMB Control Number) 2021-07-09 Approved without change

OMB Details

Application for Special Financial Assistance

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form SFA 201SFA Template 1www.pbgc.gov/sites/default/files/sfa/template-1.xlsxForm and instruction
Form SFA 100SFA Application Checklistwww.pbgc.gov/arp-sfa/more-resourcesForm and instruction
Form PBGC E-filing PortalPBGC E-filing PortalFillable FileableForm
Form SFA Template 10SFA Template 10www.pbgc.gov/documents/pre-2021-zone-certification-baseline-details-and-final-sfa-assumption-summariesForm and instruction
Form Model Plan Amendment, ReinstatementModel Plan Amendment, Reinstatementwww.pbgc.gov/sites/default/files/documents/model-plan-amendment-reinstatement.docxForm and instruction
Form SFA 100-SupplementedSFA Template Checklist, Supplemented Applicationwww.pbgc.gov/sites/default/files/sfa/checklist-supplemented-sfa-application.xlsxForm and instruction
Form www.pbgc.gov/sites/default/files/sfa/sfa-filing-instructions.pdfInstruction
Form Model CertificationModel Certificationwww.pbgc.gov/sites/default/files/documents/model-certification-plan-sponsor-reinstatement.docxForm and instruction
Form SFA Application Amendment Cover LetterSFA Application Amendment Cover Letterwww.pbgc.gov/documents/sfa-application-amendment-cover-letterForm and instruction
Form SFA Filing Instructions, Addendum DSFA Filing Instructions, Addendum DFillable FileableForm and instruction
Form SFA Filing Instructions, Addendum CSFA Filing Instructions, Addendum CFillable FileableForm and instruction
Form Model Plan Amendment ComplianceModel Plan Amendment Compliancewww.pbgc.gov/sites/default/files/documents/model-plan-amendment-compliance.docxForm and instruction
Form SFA Filing Instructions, Addendum ASFA Filing Instructions, Addendum AFillable FileableForm and instruction
Form SFA 206-ASFA Template 6Awww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6a.xlsxForm and instruction
Form SFA 207SFA Template 7www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-7.xlsxForm and instruction
Form SFA 208SFA Template 8www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-8.xlsxForm and instruction
Form SFA 209SFA Template 9www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-9.xlsxForm and instruction
Form SFA 205-BSFA Template 5Bwww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5b.xlsxForm and instruction
Form SFA 205-ASFA Template 5Awww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-5a.xlsxForm and instruction
Form SFA 206-BSFA Template 6Bwww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-6b.xlsxForm and instruction
Form SFA 204-BSFA Template 4Bwww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4b.xlsxForm and instruction
Form SFA 204-ASFA Template 4Awww.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-4a.xlsxForm and instruction
Form SFA 203SFA Template 3www.pbgc.gov/sites/default/files/sfa/part-4262-final-rule-template-3.xlsxForm and instruction
Form SFA 202SFA Template 2www.pbgc.gov/sites/default/files/sfa/template-2.xlsxForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.