View Information Collection Request (ICR) Package
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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:
1212-0055
ICR Reference No:
202504-1212-005
Status:
Historical Active
Previous ICR Reference No:
202405-1212-002
Agency/Subagency:
PBGC
Agency Tracking No:
Title:
Locating and Paying Participants
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:
04/11/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/10/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2027
06/30/2027
06/30/2027
Responses
136,081
0
136,081
Time Burden (Hours)
101,703
0
101,703
Cost Burden (Dollars)
60,742
0
60,742
Abstract:
This collection consists of information participants and beneficiaries are asked to provide in connection with an application for benefits or request for a benefit estimate. In addition, in some instances, as part of a search for participants and beneficiaries who may be entitled to benefits, the PBGC requests individuals to provide identifying information that the individual would provide as part of an initial contact with the PBGC.
Authorizing Statute(s):
PL:
Pub.L. 109 - 280 410
Name of Law: Pension Protection Act of 2006
US Code:
29 USC 1322, 1350
Name of Law: Employee Retirement Security Act (ERISA)
Citations for New Statutory Requirements:
None
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:
89 FR 8725
02/08/2024
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 43881
05/20/2024
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
Locating and Paying Participants
Form 700RN, Form 700RSC, Form 703, Form 703MP, MyPBA, Form 703RBD, Form 703RBD-MP, Form 704, Form 712, Form 713, Form 714, Form 715, Form 720MP, Form 721, Form 721T, Form 706, Form 702, Form 707, Form 700, Form 701, Form 705, Form 716, Form 708, Form 710, Form 711, Form 716A, Form 717, Form 720, Form 720CD, Form 722, 713RBD, 714RBD, 720MP Roth, 703MP Roth
MyPBA Screen Shots
,
Election of Retroactive Annuity Starting Date (Spousal Consent not Required)
,
Election of Retroactive Annuity Starting Date (Spousal Consent Required)
,
Application for Elective Lump-Sum Payment
,
Application for Elective Lump-Sum Payment
,
Application for Elective Lump-Sum Payment, post RBD
,
Application for Elective Lump-Sum Payment, post RBD
,
Report of Earnings and Social Security Disability Information
,
Uniformed Services Information Form
,
Election to Withdraw Employee Contributions
,
Withdrawal of Employee Contributions – Non-Spouse Beneficiary
,
Power of Attorney (POA)
,
Application for Lump-Sum Payment
,
Application for Eligible Rollover Payment – Non-Spouse Beneficiary
,
Tax Election for Payment Not Eligible for Rollover
,
Participant Application for Pension Benefits
,
Payee Information Form
,
General Information Form
,
Beneficiary Application for Pension Benefits
,
Beneficiary Application for Pension Benefits - OF
,
Designation of Beneficiary for Benefits Owed at Death (Currently Receiving Pension Benefits)
,
Designation of Beneficiary for Benefits Owed at Death (Not Currently Receiving Pension Benefits)
,
Application for Electronic Direct Deposit
,
Change of Beneficiary for Certain & Continuous (C&C) Benefits Only
,
Certification of Social Security Disability Status
,
Certification of Pension Plan Disability Status
,
Benefit Inquiry Questionnaire
,
Application for Lump-Sum Payment
,
Application for Lump-Sum Payment (child or dependent)
,
Financial Statement of Debtor
,
Election to Withdraw Employee Contributions, post RBD
,
Withdrawal of Employee Contributions – Non-Spouse Beneficiary
,
Application for Lump-Sum Payment Roth
,
Application for Elective Lump-Sum Payment - Roth Account
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
136,081
136,081
0
0
0
0
Annual Time Burden (Hours)
101,703
101,703
0
0
0
0
Annual Cost Burden (Dollars)
60,742
60,742
0
0
0
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:
$0
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
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:
04/10/2025
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