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OMB Control No: 1212-0074	ICR Reference No: 202503-1212-001
Status: Active	Previous ICR Reference No: 202407-1212-001
Agency/Subagency: PBGC	Agency Tracking No:
Title: Special Financial Assistance by PBGC
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: 03/24/2025
	Date Received in OIRA: 03/19/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	05/31/2027	05/31/2027
Responses	207	0	207
Time Burden (Hours)	864	0	864
Cost Burden (Dollars)	1,931,800	0	1,931,800

Abstract: 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.

Authorizing Statute(s): PL: Pub.L. 117 - 2 9704 Name of Law: American Rescue Plan Act of 2021

Citations for New Statutory Requirements: US Code: 29 USC 1432 Name of Law: American Rescue Plan Act of 2021

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:
	88 FR 88138	12/20/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 21544	03/28/2024
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Annual Statement of Compliance	SFA 300
Application for Special Financial Assistance	SFA 208, SFA 207, SFA 206-A, SFA Filing Instructions, Addendum A, Model Plan Amendment Compliance, SFA Filing Instructions, Addendum C, SFA Filing Instructions, Addendum D, SFA Application Amendment Cover Letter, SFA 100, SFA 201, SFA 202, SFA 203, SFA 204-A, SFA 204-B, SFA 206-B, SFA 205-A, SFA 205-B, SFA 209, Model Certification, SFA 100-Supplemented, Model Plan Amendment, Reinstatement, SFA Template 10, PBGC E-filing Portal	, , , , , , , , , , , , , , , , , , , , , ,
Lock-In Application	Lock-in Application
Notice of reinstatement	SFA Filing Instructions, Addendum B
Requests for determination

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	207	207
Annual Time Burden (Hours)	864	864
Annual Cost Burden (Dollars)	1,931,800	1,931,800

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: $7,700,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

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? No

Agency Contact: Karen Levin 202 326-4400 ext. 3559 levin.karen@pbgc.gov

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