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OMB Control No: 1212-0057	ICR Reference No: 202602-1212-006
Status: Received in OIRA	Previous ICR Reference No: 202504-1212-006
Agency/Subagency: PBGC	Agency Tracking No:
Title: Annual Information Return/Report
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 03/03/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2026
Responses	24,000	25,000
Time Burden (Hours)	15,518	15,089
Cost Burden (Dollars)	0	0

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Annual Information Return/Report	Form 5500-SF, Form 5500, Schedule C, Schedule D, Schedule A, Schedule DCG, Schedule G, Schedule I, Schedule H, Schedule MB, Schedule MEP, Schedule R, Schedule SB	, , , , , , , , , , , ,

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	24,000	25,000	-1,000
Annual Time Burden (Hours)	15,518	15,089	429
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The revised time burden estimate reflects Department of Labor cost allocation to PBGC under the joint cost allocation model. The revised annual response estimate is based on PBGC data consistent with its pension insurance tables.

Annual Cost to Federal Government: $800,000

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. No

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. 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? No

Agency Contact: Jose Singer-Freeman 202 701-8073 singer-freeman.jose@pbgc.gov

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