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View Information Collection (IC) List
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1212-0057
ICR Reference No:
201607-1212-001
Status:
Historical Active
Previous ICR Reference No:
201412-1212-001
Agency/Subagency:
PBGC
Agency Tracking No:
Title:
Annual Information Return/Report
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
10/25/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/12/2016
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2017
06/30/2017
06/30/2017
Responses
24,000
0
24,000
Time Burden (Hours)
1,200
0
1,200
Cost Burden (Dollars)
1,465,000
0
1,407,000
Abstract:
Sections 104 and 4065 of ERISA require plan administrators to file an annual report. The report must contain the information described in section 103 of ERISA. The Form 5500 Series provides a standard format for fulfilling that requirement.
Authorizing Statute(s):
US Code:
29 USC 1302(b)(3), 1365
Name of Law: ERISA
Citations for New Statutory Requirements:
Statute at Large: 120 Stat. 780 Name of Statute: Pension Protection Act of 2006
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 62681
10/20/2014
30-day Notice:
Federal Register Citation:
Citation Date:
80 FR 11501
03/03/2015
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Annual Information Return/Report
2016 Form 5500, 2016 Form 5500, 2016 Form 5500-SF, 2016 Form 5500-SF, 2016 Schedule A (Form 5500) , 2016 Schedule A (Form 5500), 2016 Schedule C (Form 5500), 2016 Schedule C (Form 5500), 2016 Schedule D (Form 5500), 2016 Schedule D (Form 5500), 2016 Schedule G (Form 5500), 2016 Schedule G (Form 5500), 2016 Schedule H (Form 5500), 2016 Schedule H (Form 5500), 2016 Schedule I (Form 5500) , 2016 Schedule MB (Form 5500), 2016 Schedule MB (Form 5500), 2016 Schedule R (Form 5500), 2016 Schedule R (Form 5500), 2016 Schedule SB (Form 5500), 2016 Schedule SB (Form 5500) , 2016 Schedule I (Form 5500)
2016 Annual Return/Report of Employee Benefit Plan (Clean)
,
2016 Short Form Annual Return/Report of Small Employee Benefit Plan (Clean)
,
2016 Annual Return/Report of Employee Benefit Plan (RLSO)
,
2016 Short Form Annual Return/Report of Small Employee Benefit Plan (RLSO)
,
2016 Schedule A (Form 5500) - Insurance Information (Clean)
,
2016 Schedule A (Form 5500) - Insurance Information (RLSO)
,
2016 Schedule C (Form 5500) - Service Provider Information (Clean)
,
2016 Schedule C (Form 5500) - Service Provider Information (RLSO)
,
2016 Schedule D (Form 5500 - DFE/Participating Plan Information (Clean)
,
2016 Schedule D (Form 5500) - DFE/Participating Plan Information (RLSO)
,
2016 Schedule G (Form 5500) - Financial Transaction Schedules (Clean)
,
2016 Schedule G (Form 5500) - Financial Transaction Schedules (RLSO)
,
2016 Schedule H (Form 5500) - Financial Information (Clean)
,
2016 Schedule H (Form 5500) - Financial Information (RLSO)
,
2016 Schedule I (Form 5500) - Financial Information - Small Plan (Clean)
,
2016 Schedule I (Form 5500) - Financial Information - Small Plan (RLSO)
,
2016 Schedule MB (Form 5500) - Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information (Clean)
,
2016 Schedule MB (Form 5500) - Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information (RLSO)
,
2016 Schedule R (Form 5500) - Retirement Plan Information (Clean)
,
2016 Schedule R (Form 5500) - Retirement Plan Information (RLSO)
,
2016 Schedule SB (Form 5500) - Single-Employer Defined Benefit Plan Actuarial Information (Clean)
,
2016 Schedule SB (Form 5500) - Single-Employer Defined Benefit Plan Actuarial Information (RLSO)
ICR Summary 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
24,000
24,000
0
0
0
0
Annual Time Burden (Hours)
1,200
1,200
0
0
0
0
Annual Cost Burden (Dollars)
1,465,000
1,407,000
0
0
58,000
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:
Annual Cost to Federal Government:
$822,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
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?
Uncollected
Agency Contact:
Grace Kraemer 2023264223 ext. 3865 kraemer.grace@pbgc.gov
Common Form ICR:
No
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:
10/12/2016
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