View Information Collection Request (ICR) Package

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: 1212-0072	ICR Reference No: 202607-1212-004
Status: Active	Previous ICR Reference No: 202511-1212-002
Agency/Subagency: PBGC	Agency Tracking No:
Title: Request for Coverage Determination
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: 08/07/2026
	Date Received in OIRA: 07/29/2026
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2028	06/30/2028	06/30/2028
Responses	295	0	295
Time Burden (Hours)	443	0	443
Cost Burden (Dollars)	88,500	0	88,500

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	295	295
Annual Time Burden (Hours)	443	443
Annual Cost Burden (Dollars)	88,500	88,500

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: The changes to the estimates of hour and cost burdens of this collection of information are due primarily to the slight decrease in PBGC’s estimate of the number of Request for Coverage Determination forms it expects to receive annually.

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: Andrew Wilson 202 860-8354 wilson.andrew1@pbgc.gov

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