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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Locating and Paying Participants
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
Form 701
Payee Information
e_Form 701- Payee Information.docx
No
Paper Only
Form and Instruction
Form 702
General Information
e_Form 702 General Information Form.docx
No
Paper Only
Form and Instruction
Form 703
Application for Elective Lump-Sum Payment
e_Form 703 Application for Elective Lump-Sum Payment.docx
No
Paper Only
Form and Instruction
Form 703MP
Application for Elective Lump-Sum Payment
e_Form 703MP Application for Elective Lump-sum Payment.docx
No
Paper Only
Form and Instruction
Form 704
Report of Earnings and Social Security Disability Information
e_Form 704 Report of Earnings and Social Security Disability Information.docx
No
Paper Only
Form and Instruction
Form 700
Participant Application for Pension Benefits
e_Form 700 Participant Application for Pension Benefits.docx
No
Paper Only
Form and Instruction
Form 705
Beneficiary Application for Pension Benefits
e_Form 705 Beneficiary Application for Pension Benefits.docx
No
Paper Only
Form and Instruction
Form 706
Beneficiary Application for Pension Benefits
e_Form 706 Beneficiary Application for Pension Benefits - OF.docx
No
Paper Only
Form and Instruction
Form 707
Designation of Beneficiary for Benefits Owed at Death
e_Form 707 Designation of Beneficiary for Benefits Owed at Death.docx
No
Paper Only
Form and Instruction
Form 708
Designation of Beneficiary
e_Form 708 Designation of Beneficiary.docx
No
Paper Only
Form and Instruction
Form 709
Plan Participant Information
e_Form 709 Plan Participant Information.docx
No
Paper Only
Form and Instruction
Form 710
Application for Direct Deposit
e_Form 710 Application for Direct Deposit.docx
No
Paper Only
Form and Instruction
Form 711
Change of Beneficiary for Certain Continuous Benefits Only
e_Form 711 Change of Beneficiary for Certain continuous (CC) Benefits Only.docx
No
Paper Only
Form and Instruction
Form 712
Uniformed Services Information Form
e_Form 712 Uniformed Services Information Form.docx
No
Paper Only
Form and Instruction
Form 713
Election fot Withdraw Employee Contributions
e_Form 713 Election to Withdraw Employee Contributions.docx
No
Paper Only
Form and Instruction
Form 714
Withdrawal of Employee Contributiions
e_Form 714 Withdrawal of Employee Contributions - Non-Spouse Beneficiary.docx
No
Paper Only
Form and Instruction
Form 716
Certification of Social Security Disability
e_Form 716 Certification of Social Security Disability Status.docx
No
Paper Only
Form and Instruction
Form 716A
Certificate of Pension Plan Disability Status
e_Form 716A Certificate of Pension Plan Disability Status.docx
No
Paper Only
Form and Instruction
Form 718
Installment Payment Agreement
e_Form 718 Installment Payment Agreement.docx
No
Paper Only
Form and Instruction
Form 719
Election to Withhold Federal Income Tax from Periodic Payment
e_Form 719 Election to Withhold Federal Income Tax from Periodic Payment.docx
No
Paper Only
Form and Instruction
Form 720
Application for Lump-Sum Payment
e_Form 720 Application for Lump-Sum Payment.docx
No
Paper Only
Form and Instruction
Form 720CD
Application for Lump-Sum Payment
e_Form720CD Application for Lump-Sum Payment.docx
No
Paper Only
Form and Instruction
Form 720MP
Application for Lump-Sum Payment
e_Form720MP Application for Lump-Sum Payment.docx
No
Paper Only
Form and Instruction
Form 721
Application for Eligible Rollover Payment - Non-Spouse Beneficiary
e_Form721 Application for Eligible Rollover Payment - Non-Spouse Beneficiary.docx
No
Paper Only
Form and Instruction
Form 721T
Tax Election for Payment Not Eligible for Rollover
e_Form721T Tax Election for Payment Not Eligible for Rollover.docx
No
Paper Only
Form and Instruction
Form 722
Financial Statement of Debtor
e_Form722 Financial Statement of Debtor.docx
No
Paper Only
Other-Screen shots
MyPBA screens related to PBGC forms.docx
Yes
Yes
Fillable Fileable
Form and Instruction
Form 717
Benefit Inquiry Questionnaire
Form 717 - Benefit Inquiry Questionnaire.pdf
No
Paper Only
Form and Instruction
715
Power of Attorney (POA)
e_Form 715D 05152018.pdf
Yes
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
175,397
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
175,397
0
121,087
0
0
54,310
Annual IC Time Burden (Hours)
108,440
0
-17,650
0
0
126,090
Annual IC Cost Burden (Dollars)
56,711
0
55,351
0
0
1,360
Documents for IC
Title
Document
Date Uploaded
Long Privacy Act Notice 2018
Privacy Act Notice - Long Clean 2018.pdf
08/03/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.