4010 screen shots (pre-PPA)

SCREEN 1a
Help

Account Sign-Up
Error messages (EM##) shown here

First name:
Last name:
Company:
Title:
Work address:

City:
State:
Province (if outside the USA):
Country:
Zip code:

(ex. 22222-2222)

Telephone:

Ext.

Email address:

(ex. aa@a.com)

Confirm email address:
Secret question:
Secret answer:
Cancel
PBGC.gov | Paperwork Reduction Act Notice
User selects one of the following Secret Question options:
1) In what city were you born?
2) From what high school did you graduate?
3) What is your mother's maiden name?
4) What is your pet's name?

Next >

SCREEN 1b
Help

Log In
Error messages (EM##) shown here

SECURITY NOTICE AND WARNING
Welcome to the ERISA 4010 ("e-4010") website. This website is a U.S. Government
system and the PBGC reserves the right to monitor it for performance, stability, and
security. This site, and the information on it, is protected by federal laws, including, but not
limited to, federal privacy laws and any activity inconsistent with the protections provided
by federal law may lead to civil and criminal sanctions. By logging into e-4010, you
acknowledge that you understand that you are bound by these provisions. If you do not,
please close your browser or enter another URL to leave the site entirely.

New to e-4010?

Apply for an Account

Go to Screen 1a

Already Have an Account? Log in.
User ID:

Forgot your User ID?

Password:

Forgot your password?
Login

If first time logging in, then go to
Screen 2, else go to screen 8

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SCREEN 2
Help

First Time Login
Error messages (EM##) shown here

Step 1: Enter New User ID
Your User ID can be any combination of letters and/or numbers and it must be between 8 and 25
characters long. Your User ID is not case sensitive. This will be the last time that you will be able to
change your User ID.

Step 2: Enter a New Password
Your password must contain at least one letter and one number and it must be between 8 and 12
characters long. Your password is case sensitive, so make sure to enter it exactly as you do here
when you log in to the e-4010 system.

Confirm New Password

Step 3: Enter Your Security Key
Secret Question:

In what city were you born?

Secret Answer:

Save

Cancel

PBGC.gov | Paperwork Reduction Act Notice
This field will be pre-populated with the Secret Question the filer has
supplied which will be one of the following:
1) In what city were you born?
2) From what high school did you graduate?
3) What is your mother's maiden name?
4) What is your pet's name?

Back to Login
Page (Screen 1b)

Go to Homepage
(Screen 8)

SCREEN 3
Help

Forgot/Reset Password
Error messages (EM##) shown here

Email address:

(ex. aa@a.com)

Secret question:
Secret answer:

Cancel

PBGC.gov | Paperwork Reduction Act Notice

This selection options for the Secret Question will be one of
the following:
1) In what city were you born?
2) From what high school did you graduate?
3) What is your mother's maiden name?
4) What is your pet's name?

Submit

SCREEN 4

Help

Forgot User ID
Error messages (EM##) shown here

Email address:

Secret question:

(ex. aa@a.com)

Secret answer:

Cancel

PBGC.gov | Paperwork Reduction Act Notice
This selection options for the Secret Question will be one of
the following:
1) In what city were you born?
2) From what high school did you graduate?
3) What is your mother's maiden name?
4) What is your pet's name?

Submit

SCREEN 5

Help

Change Password
Error messages (EM##) shown here

New Password:
Confirm Password:
Secret Question: In what city were you born?
Secret Answer:
Cancel

PBGC.gov | Paperwork Reduction Act Notice

The question originally selected by the user during account sign-up is
automatically displayed.

Next >

SCREEN 6
Help

Change Temporary Password
Error messages (EM##) shown here

Step 1: Enter a New Password
Your password must contain at least one letter and one number and it must be between 8 and 12
characters long. Your password is case sensitive, so make sure to enter it exactly as you do here
when you log in to the e-4010 system.

Confirm New Password

Step 2: Enter Your Security Key
Secret Question:

In what city were you born?

Secret Answer:

Cancel
PBGC.gov | Paperwork Reduction Act Notice
This field will be pre-populated with the Secret Question the filer has
supplied which will be one of the following:
1) In what city were you born?
2) From what high school did you graduate?
3) What is your mother's maiden name?
4) What is your pet's name?

Save

SCREEN 7
Help

Manage Account
Error messages (EM##) shown here

First name:
Last name:
Company:
Title:
Work address:

City:
State:
Province (if outside the USA):
Country:
Zip code:
Telephone:

(ex. 22222-2222)

Ext.

Email address:

(ex. aa@a.com)

Confirm email address:
Secret question: In what city were you born?
Secret answer:
Cancel
PBGC.gov | Paperwork Reduction Act Notice

Save

SCREEN 8

Manage Account | Change Password | Logout | Help

e-4010 Home Page
Controlled Group Filing Drafts
Information
Year-end
12/31/2005

Create New 4010 Filing

Date
Created

Name

04/04/2006

ABC Holdings, Inc.
Edit Schedule P

12/31/2005

04/09/2006

Delete Filing

Reassign

Delete Filing

Reassign

Amend Filing

Reassign

Amend Filing

Reassign

Amend Filing

Reassign

XYZ Holdings, Inc.
Edit Filing

Controlled Group Filings Submitted to PBGC
Information Original
Amended
Year-end Submission Submission
Date
Date
12/31/2005

04/15/2006

N/A

Name

JKL Holdings, Inc.
View Schedule P

12/31/2005

03/13/2006

N/A

EFG Holdings, Inc.
View Filing

12/31/2005

03/13/2006

01/15/2005

EFG Holdings, Inc.
View Filing

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If user is the Filing Coordinator for this filing, the
button will be labeled “View Filing" and the
printable format of the filing will be displayed.
If the user has been assigned as an actuary,
the button will be labeled “View Schedule P”
and the printable format for those schedule P’s
completed by the current user will be displayed.
If user is the Filing Coordinator for this
filing, the button will be labeled “Edit
Filing” and will take the user to the Filing
Summary (Screen 11).
If user has been assigned as an actuary
for this filing, the button will be labeled
“Edit Schedule P” and will take the user
to the Schedule P Summary which will
display only those Schedule P’s to which
the actuary has been assigned.

This button will only
appear if the user is
a Filing Coordinator
for the filing. It will
delete a 4010 filing
in process.

This button will only appear if the
user is a Filing Coordinator for
the filing. It will copy the data
from the submitted filing and
create a new one. The new filing
will be marked as “amended”.
Go to filing summary (screen 11).

Go to screen 9.
This will initiate
a new 4010
filing.

This button will only
appear if the user is
a Filing Coordinator
for the filing. Go to
screen 42 to assign
this filing to a new
coordinator.

SCREEN 9
Help

E-4010 - Create New Filing
Error messages (EM##) shown here

Select option for new filing:
Pre-populate with data from previously submitted filing
Do not pre-populate

If answer to is “pre-populate”, go to
screen 10. If answer is “do not prepopulate”, go to Schedule G (screen 12).

Cancel

PBGC.gov | Paperwork Reduction Act Notice

Back to Home Page (Screen 8)

Next >

SCREEN 10
Help

E-4010 - Create New Filing
Error messages (EM##) shown here

Select the prior filing from which data will
be extracted to pre-populate the new filing:

Drop down list of past filings.
Go to pre-populated
Schedule G (Screen 12).

Cancel

Next >

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Back to Home Page (Screen 8)

This screen shown if existing filing is clicked from home page or after a filing is deemed necessary in
Schedule FG

SCREEN 11

Manage Account | Change Password | Logout | Help

Filing Summary
Controlled Group: ABC Holdings, Inc.
Schedules
Schedule G
Schedule FG

Comments

To Screen 12

Comments

To Screen 13

Schedule I
Section I (Member Information)
Section II (Plan Information)

Comments

Attachments

Comments

Attachments

To Screen 17
To Screen 20

Section III (Prior member/plan information)
Schedule F
Schedule P
e-4010 Homepage

View Draft

Validate Filing

Submit Filing

PBGC.gov | Paperwork Reduction Act Notice
To Screen 34
To Screen 27 if
first time
through. To
Screen 28 if
“Consolidated/
Individual not
yet indicated
OR if
“Combined” and
a new, nonexempt plan
has been
added.
Otherwise, go
to Screen 29.

To Screen 8
To Screen 26
(Will show
message that
this section is
not required if
no changes
were made
from last year.)

To Screen 41
Will display a
page that
contains a
summary of all
the missing
information
that is needed
for submission
to PBGC

To Screen 40

Will display a
page that
contains a
summary of the
filing
information
entered thus
far.

Sets status of filing to
“Submitted”.
Validations are
performed to ensure
that filing is complete.
If so, then mark filing
as submitted. At this
time, it is no longer
editable by user, and
they can now print the
form as a receipt. This
filing will also appear
on the lower section of
the the homepage
under the “Controlled
Group Filings
Submitted to PBGC”
section.

If user created a new filing from a previous one, “Name”, “Business Code”, and “CUSIP
number” will be pre-populated.

SCREEN 12

Help

Schedule G - General Information
Error messages (EM##) shown here

Controlled Group Information
Name:
Business code:

(ex. 111111)

CUSIP number:

(enter first 6 digits only)

Date current information
year ends:

(ex. MM/DD/YYYY)

Filing Contact (if different from filing coordinator)
General contact
information:

General Filing Information
Was a 4010 filing required last year?
Yes

If answer is “No” to both, display message indicating that a filing
does not need to be submitted (Screen 16c)

No

Is a 4010 filing required this year?
Yes

No

Help me determine

If choose “Help Me Determine”,
display Schedule FG to test need.

Check this box if §4010.6(c) exception for previously submitted
materials applies (see instructions)

Back to Home
Page (Screen 8)
Cancel

Next >

PBGC.gov | Paperwork Reduction Act Notice
If filer indicates that a filing is
required this year, Schedule FG
can be bypassed.

If a filing was required last year and the
user indicates that one is not required
this year, then the filer must complete
and submit Schedule FG to prove that a
filing is not required again.

On to FG test (Screen
13) or Filing Summary
Page (Screen 11), or
message indicating that
no Filing is necessary
(Screen 16c)

SCREEN 13

Help

Schedule FG - Filing Gateway
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

1. §4010.4(a)(1) - $50 million aggregate unfunded vested benefits
a. Does the total amount of aggregate unfunded vested benefits in plans (including exempt plans)
maintained by the members of the contributing sponsor's controlled group exceed $50 million
(disregarding those plans with no unfunded vested benefits)?
Yes

No
Cancel

Next >

PBGC.gov | Paperwork Reduction Act Notice

Back to Filing Summary (Screen 11)
If “Yes” go to message indicating
a Filing is required (Screen 16a).
If “No” go to Screen 14.

SCREEN 14

Help

Schedule FG - Filing Gateway
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

2. §4010.4(a)(2) - Failure to make required contributions
Did any member of the controlled group:
fail to make a required contribution to a defined benefit plan during the information year within 10
days of its due date, and
as a result of the missed contribution, the conditions for imposition of a lien under ERISA have
been met?
Yes

No
< Back

Cancel

Next >

PBGC.gov | Paperwork Reduction Act Notice

Back to Filing Summary (Screen 11)
If “Yes” go to message indicating
a Filing is required (Screen 16a).
If “No” go to Screen 15.

SCREEN 15

Help

Schedule FG - Filing Gateway
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

3. §4010.4(a)(3) - Large waiver granted
Have one or more minimum funding waivers been granted for a plan maintained by a member of the
controlled group:
totaling in excess of $1 million, and
for which there is an outstanding balance as of the end of the plan year ending within the
information year (determined in accordance with § 4010.4(c))?
Yes

No
< Back

Cancel

Next >

PBGC.gov | Paperwork Reduction Act Notice

Back to Filing Summary (Screen 11)
If “Yes”, display message indicating a Filing is
required (Screen 16a).
If “No”, and a filing was required last year, display
message indicating that only Schedule FG needs
to be submitted (Screen 16b)
If “No”, and a filing was not required last year,
display message indicating that a filing does not
need to be submitted (Screen 16c)

SCREEN 16a

Help

ERISA 4010 Filing Required
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

Based on the information you have provided, an e-4010 filing is required. Click on the button below to
display the Filing Summary page.

Go to Filing Summary Page

PBGC.gov | Paperwork Reduction Act Notice

Display Screen 11

SCREEN 16b

Help

ERISA 4010 Filing Not Required (Only Schedules G and FG)
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

Based on the information you have provided, an e-4010 filing is not required. However, you must submit
Schedules G and FG that you have just completed. Click on the button below to display the Filing Summary
page. From there, you can choose to submit the filing to PBGC or review the information entered into
Schedules G and FG prior to submission.

Go to Filing Summary Page

PBGC.gov | Paperwork Reduction Act Notice

Display Screen 11

SCREEN 16c

Help

No ERISA 4010 Filing Required
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

Based on the information you have entered, you do not have to submit a filing to PBGC.

Go to e-4010 Home Page
PBGC.gov | Paperwork Reduction Act Notice
Display Screen 8

At least one “Yes” was entered on Filing Gateway test question for this screen to be necessary

SCREEN 17

Manage Account | Change Password | Logout | Help

Schedule I - Identifying Information
Section I - Controlled Group Members - Summary
Controlled Group: ABC Holdings, Inc.
Member Company

EIN

ABC Holdings, Inc.

10-7894561

Delete

ABC Manufacturing, Inc.

10-7894562

Delete

ABC Distribution, Inc.

10-7894563

Delete

ABC Technologies Corp.

10-7894564

Delete

ABC Enterprises, Inc.

10-7894565

Delete

ABC Healthcare, LLP

10-7894566

Delete

ABC Resources, Inc.

10-7894567

Delete

Enter Member Company

Back to Filing Summary

PBGC.gov | Paperwork Reduction Act Notice
Display Screen 18

Display Screen 11

Delete Member

SCREEN 18
Help

Schedule I - Identifying Information
Section I - Controlled Group Members
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

Company name:
EIN:

(ex. 11-1111111)

Address:

City:
State:

Province (if outside the USA):
Country:
Zip code:
Telephone:

(ex. 22222-2222)

Ext.

Back to Filing
Summary (Screen 11)
Go to Screen 19

Relationship:

Cancel

PBGC.gov | Paperwork Reduction Act Notice

Next >

SCREEN 19

Help

Schedule I.I
I - –Identifying
Information
Schedule
Basic Member
Information
Section I - Controlled Group Members
Controlled Group: ABC Holdings, Inc.
Member: ABC Financials, Inc.
Error messages (EM##) shown here

Information on new members
Was this member a member of the controlled group immediately
before the current information year began?
Yes
No, member joined controlled group during information year
No, other

Date Joined:

(ex. MM/DD/YYYY)

Back to Screen 17 (no save)
Back to Screen 17

< Back

Cancel

PBGC.gov | Paperwork Reduction Act Notice

Save

Back to Screen 18

Enter Next Member

SCREEN 20

Manage Account | Change Password | Logout | Help

Schedule I - Identifying Information
Section II - Plans - Summary
Controlled Group: ABC Holdings, Inc.
Plan Name

Sponsor

EIN/PN

Exempt?

Plan A

ABC Financials, Inc.

10-7894561/001

No

Delete

Assign to Actuary

Plan B

ABC Financials, Inc.

10-7894561/002

No

Delete

Assign to Actuary

Plan C

ABC Textiles, Inc.

10-7894563/001

No

Delete

Unassign Actuary

Plan D

ABC Wheels, Inc.

10-7894564/001

Yes

Delete

Enter Plan

Modify Member Information

Back to Filing Summary

PBGC.gov | Paperwork Reduction Act Notice
Go to Screen 21 (enter new)
As users enter new plans, they
appear in this list. The
hyperlinks will open Screen 21
with the data pre-populated for
further editing if necessary.

Go to Screen 17

Back to Screen 11

These buttons will only appear next
to plans that were designated notexempt (Screen 21).
If assigning actuary, go to screen 43.
If removing an assigned actuary,
show confirmation screen and
remove actuary from Schedule P. If
actuary was assigned and has
completed and pressed the “Notify
FC” button (on page 39), the label
will revert to “Assign to Actuary”.

SCREEN 21
Help

Schedule I - Identifying Information
Section II - Plans
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

Drop down list of members from
Screen 17 (Schedule I.I) - will be
formatted as “Member Name/EIN”

Information for current year
Plan name:
Plan sponsor:
Plan number (PN):

Enter New Member
(ex. 333)

Go back to Screen 18 (Schedule I.I
entry page).

Is this an exempt plan about which benefit liabilities are not required to be reported?
Yes

No

All plans designated as “non-exempt” will show
up on the Schedule P Summary (Screen 34)

Is this plan frozen for eligibility or benefit accrual purposes (see instructions)?
Yes

No

If frozen, display screen 22
If not frozen display 23a

Cancel

Next >

PBGC.gov | Paperwork Reduction Act Notice
Will require that
Screen 22 be
displayed

Back to Schedule Summary (Screen 12)

This page displayed only if the plan freeze question was answered “yes” (last question on Screen 21)

SCREEN 22

Help

Schedule I - Identifying Information
Section II - Plans
Controlled Group: ABC Holdings, Inc.
Member: ABC Financials, Inc.
Plan: Plan A
Error messages (EM##) shown here

Information related to plan freezes
Date of freeze:

(ex. MM/DD/YYYY)

Nature of freeze:
Plan closed to new entrants
Both pay and service are frozen
Service is frozen, but pay is not
Other/combination, enter explanation:

Cancel

Next >

PBGC.gov | Paperwork Reduction Act Notice

Back to Screen 20
(no save)

Go to Screen 23a

SCREEN 23a

Help

Schedule I - Identifying Information
Section II - Plans
Controlled Group: ABC Holdings, Inc.
Member: ABC Financials, Inc.
Plan: Plan A
Error messages (EM##) shown here

Information on changes in EIN/PN
Has the EIN or PN changed since the beginning of the current information year?
Yes

No

N/A (new plan)

If “N/A”, will require that
screen 25 be displayed.
If “Yes”, will require that
Screen 24 be displayed.

If “No”, then finished
with this plan. Go to
Screen 23b.

< Back

PBGC.gov | Paperwork Reduction Act Notice

Cancel

Next >

Depending upon
answer on this page,
go to Screen 23b, 24,
or 25

Back to Screen 20 (no save)

SCREEN 23b
Help

Schedule I - Identifying Information
Section II - Plans
Controlled Group: ABC Holdings, Inc.
Member: ABC Financials, Inc.
Plan: Plan B
Plan Information Completed
Note: The text below is from message CS10

The information entered for this plan is now complete. Please click on the "Enter Next Plan" button below to
enter information for an additional plan.

< Back

Cancel

Save

PBGC.gov | Paperwork Reduction Act Notice

Enter Next Plan

Back to Screen 21
Back to Screen 20

Back to Screen 20 (no save)

This page displayed if changes were made since the beginning of the year (“Yes” to the question on
Screen 23a)

SCREEN 24

Help

Schedule I - Identifying Information
Section II - Plans
Controlled Group: ABC Holdings, Inc.
Member: ABC Financials, Inc.
Plan: Plan A
Error messages (EM##) shown here

Information on changes in EIN/PN
Prior EIN:
Prior PN:

(ex. 11-1111111)
(ex. 333)

< Back

Cancel

Save

PBGC.gov | Paperwork Reduction Act Notice

Enter Next Plan

Back to Screen 21
Back to Screen 20

Back to Screen 20 (no save)

SCREEN 25

This screen will appear only if “N/A (new plan)” was selected on Screen 23a.

Help

Schedule I - Identifying Information
Section II - Plans
Controlled Group: ABC Holdings, Inc.
Member: ABC Financials, Inc.
Plan: Plan B
Error messages (EM##) shown here

New plan information
Date plan was first maintained
by controlled group:

(ex. MM/DD/YYYY)

Explanation:
Newly established plan
Spun-off or transferred from plan sponsored by member outside controlled group
Spun-off from plan sponsored by member within controlled group
Other, enter explanation:

< Back

Cancel

Save

Enter Next Plan

PBGC.gov | Paperwork Reduction Act Notice
Back to Screen 21
Back to Screen 20
Back to Screen 20 (no save)

SCREEN 26

Help

Schedule I - Identifying Information
Section III - Prior Members/Prior Plans
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

Former controlled group members
If any entity, other than an exempt entity, ceased to be a member of the controlled group during the
information year, enter required information with respect to that entity (see instructions).

Former plans

If any plan, other than an exempt plan, ceased to be maintained by a member of the controlled group
during the information year, enter required information with respect to that plan (see instructions).

Cancel

Save

PBGC.gov | Paperwork Reduction Act Notice
Back to Screen 11
Back to Screen 11 (no save)

This page will be displayed by clicking on “Schedule F” from the filing summary if user has not yet
indicated consolidated or individual filings. User can come back to this screen at any time to change
settings by pressing the “Change Consolidated or Individual Submission Status” button on Screen 29.

SCREEN 27

Help

Schedule I.I
F -–Financial
Information
Schedule
Basic Member
Information
Type of Submission
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

Which of the permissible filing alternatives is being used?
§4010.9(a) - separate financial information (financial statements or tax returns) for each non-exempt controlled
group member will be provided
§4010.9(b) - consolidated financial information that includes combined information for all non-exempt controlled
group members will be provided
Consolidated financial information that includes combined information for some, but not all, controlled group
members will be provided, along with separate financial information for those non-exempt members whose
information is not included in the consolidated information.
Cancel

Next >

Consolidated
PBGC.gov | Paperwork Reduction Act Notice

If all are separate or all are consolidated,
will not need Screen 20. If there are
some individual and some consolidated,
Screen 20 will be displayed next.

Go to Screen
28 or 29

Back to Screen 11 (no save)

SCREEN 28

This screen will appear only if a combination of consolidated and individual is being reported

Help

Schedule I.I
F -–Financial
Information
Schedule
Basic Member
Information
Type of Submission
Controlled Group: ABC Holdings, Inc.
Indicate whether the financial information for the following non-exempt members will be submitted individually
or consolidated:
Member Company

EIN

ABC Holdings, Inc.

10-7894561

ABC Manufacturing, Inc.

10-7894562

ABC Distribution, Inc.

10-7894563

ABC Technologies Corp.

10-7894564

Consolidated

Individual

Cancel

PBGC.gov | Paperwork Reduction Act Notice

Save

Go to Screen 29
Back to Screen 11 (no save)

Show only those members that were
marked as “non-exempt” on Schedule I.I
(last question on Screen 10)

SCREEN 29

Manage Account | Change Password | Logout | Help

Schedule I.I
F -–Financial
Information
- Summary
Schedule
Basic Member
Information
Controlled Group: ABC Holdings, Inc.
Go to Screen 28

Change Consolidated or Individual Submission Status

Consolidated Members
Member Company

EIN

Complete

ABC Holdings, Inc.

10-7894561

Yes

ABC Distribution, Inc.

10-7894563

No

Edit

Go to Screen 30

Individually Listed Members
Member Company

EIN

Complete

ABC Manufacturing, Inc.

10-7894562

Yes

Edit

ABC Distribution, Inc.

10-7894564

No

Edit

Modify Member Information

Back to Filing Summary

PBGC.gov | Paperwork Reduction Act Notice

Back to Screen 11

Displays all members on Schedule I.I
Go to Screen 17

SCREEN 30

Help

Schedule F – Financial Information
Controlled Group: ABC Holdings, Inc.
Member: ABC Distribution, Inc.

Display “Consolidated” or
“Member: [Plan Name]”.

Error messages (EM##) shown here

Reporting Method
What type of information is being reported?
Audited financial statements

Go to Screen 31

Unaudited financial statements
Federal tax returns
< Back

Cancel

Next >

PBGC.gov | Paperwork Reduction Act Notice

Back to Screen 29 (no save)

SCREEN 31

Help

Schedule F – Financial Information
Controlled Group: ABC Holdings, Inc.
Member: ABC Distribution, Inc.

Display “Consolidated” or
“Member: [Plan Name]”.

Error messages (EM##) shown here

Reporting Method
If individually submitting financial information,

Will financial information be attached to this filing?
first question is displayed
Will consolidated financial information be attached to this filing?

If consolidated financial information, second
question is displayed

Yes
No, because it is publicly available
Will require that Screen
32 be displayed

< Back

Cancel

Next >

PBGC.gov | Paperwork Reduction Act Notice
Back to Screen 29 (no save)
To Screen 32 if information is
publicly available. If not, and
is for consolidated, go to
Screen 33. If not and
individual, display message
indicating that Schedule F is
complete.

SCREEN 32

Help

Schedule F – Financial Information
Controlled Group: ABC Holdings, Inc.
Member: ABC Distribution, Inc.

Display “Consolidated” or
“Member: [Plan Name]”.

Error messages (EM##) shown here

Reporting Method
Where can the publicly available information be obtained?
SEC
Elsewhere, enter explanation:

Date information was made available to the public:
(ex. MM/DD/YYYY)

< Back

Cancel

Next>
Save

PBGC.gov | Paperwork Reduction Act Notice

Back to Screen 29 (no save)

If is consolidated, go to
Screen 33. If individual,
display message
indicating that Schedule
F is complete.

SCREEN 33

This screen is only to be shown for consolidated members

Help

Schedule F – Financial Information
Controlled Group: ABC Holdings, Inc.
Consolidated

Display “Consolidated” or
“Member: [Plan Name]”.

Error messages (EM##) shown here

Additional Required Financial Information for each Non-Exempt Member of the Controlled Group
ABC Holdings, Inc. / 10-7894561
Revenues for the current information year: $
Operating income for the current information year: $
Net assets at the end of the current information year: $
List out each member that is
indicated as “Consolidated” on
Screen 28 of Schedule F.

ABC Distribution, Inc. / 10-7894562
Revenues for the current information year: $
Operating income for the current information year: $
Net assets at the end of the current information year: $

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Summary (Screen 29)

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SCREEN 34

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Schedule P – Plan Actuarial Information - Summary
Controlled Group: ABC Holdings, Inc.
Plan Name
Plan A
Comments

ABC Holdings, Inc.
Attachments

Print Schedule P Certification

Plan B
Comments

Print Schedule P Certification

Plan C
Comments

Print Schedule P Certification

Plan D
Comments

Print Schedule P Certification

10-7894561/002

N

10-7894563/001

N

10-7894564/001

N

Notify FC

ABC Distribution, Inc.
Attachments

Y

Notify FC

ABC Technologies, Inc.
Attachments

10-7894561/001
Notify FC

ABC Holdings, Inc.
Attachments

Complete?

EIN/PN

Sponsor

Notify FC

Modify Member Information

Modify Plan Information

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Go to Screen 41
Go to Screen 40

Hyperlinks to Screen 35 (prepopulated if already filled out).
Displays only those plans that
were marked as “non-exempt”
on Schedule I.II (Screen 21)

These buttons will open this
plan's Schedule P for printing
Go to Screen 17

Back to Screen 11

Go to Screen 20

These buttons will only appear if this
schedule P has been assigned to an
actuary. When pressed, a confirmation
page will be displayed asking the
actuary if they are sure they want to
notify the FC that the Schedule has
been completed.

SCREEN 35

Help

Schedule P – Plan Actuarial Information
Basic Plan Information
Controlled Group: ABC Holdings, Inc.
Plan Sponsor: ABC Financials, Inc.
Plan Name: Plan A: 10-7894562/001
Error messages (EM##) shown here

Enrolled Actuary Information
First name:
Last name:
EA number
Telephone:

(ex. 02-1111)
(ex. 111-111-1111)

Ext.

E-mail (optional):

(ex. aa@a.com)

Enter the following information with respect to the plan year ending within the information year
Plan year end:

(ex. MM/DD/YYYY)

Is this plan year a short plan year?
Yes

No

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SCREEN 36

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Schedule P – Plan Actuarial Information
Funded Status Information
Controlled Group: ABC Holdings, Inc.
Plan Sponsor: ABC Financials, Inc.
Plan Name: Plan A: 10-7894562/001
Error messages (EM##) shown here

Participant Counts and Benefit Liabilities
Benefit Liabilities

Number of Participants

Participant Status

(Before reflecting expense load)

Active

###,###

$

###,###,###

Terminated vested

###,###

$

###,###,###

Receiving benefits

###,###

$

###,###,###

###,###

$

###,###,###

Expense load per § 4044.52(e)

$

###,###,###

Total Benefit Liabilities*

$

###,###,###

Total
Benefit Liabilities after reflecting expense load

* Determined using assumptions (i.e. retirement age, interest, mortality, expense load)
provided in §4044.51-57
Clicking button will calculate and display total benefit
liabilities before and after expense load as been factored in

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SCREEN 37

Help

Schedule P – Plan Actuarial Information
Funded Status Information
Controlled Group: ABC Holdings, Inc.
Plan Sponsor: ABC Financials, Inc.
Plan Name: Plan A: 10-7894562/001
Error messages (EM##) shown here

Census Data used to determine benefit liabilities:
Projected from a date within the plan year ending within the information year
As of the end of the plan year ending within the information year or the beginning of the subsequent year

Interest rate used to determine benefit liabilities
years

Period 1:

% for first

Period 2:

% for all years thereafter

(ex. 4.21% for first 20 years)

Fair market value of assets (excluding receivables):

$

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SCREEN 38

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Schedule P – Plan Actuarial Information
Additional Actuarial Information
Controlled Group: ABC Holdings, Inc.
Plan Sponsor: ABC Financials, Inc.
Plan Name: Plan A: 10-7894562/001
Error messages (EM##) shown here

Which of the following five statements describes the method under which the additional information required
under §4010.8(a)(3) will be provided?
All of the information is included in one actuarial valuation report. It is my understanding that the report will be
submitted:
As an attachment to this filing
Electronically within 15 days of the IRS Form 5500 filing deadline for the plan year ending within the information
year

The actuarial valuation report does not contain all of the additional required information. Therefore, supplemental
information will also be provided. It is my understanding that the report and the supplemental information will be
submitted:
As an attachment to this filing
Electronically within 15 days of the IRS Form 5500 filing deadline for the plan year ending within the information
year
A combination of the two above
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SCREEN 39

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Schedule P – Plan Actuarial Information
Controlled Group: ABC Holdings, Inc.
Plan Sponsor: ABC Financials, Inc.
Plan Name: Plan A: 10-7894562/001
Actuarial Information Completed
You have reached the end of this schedule.

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Show appropriate Schedule depending on button pushed on Filing Summary (Screen 11)
or Schedule P Summary (Screen 34).

SCREEN 40

Help

Schedule I/F/P – Attachments
Controlled Group: ABC Holdings, Inc.
Attachments

Description

org_chart1.pdf

org chart for the controlled group

Delete

sal_avg.doc

valuation report for the salaried plan

Delete

Browse

File:
Description:

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Back to Filing Summary

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Files are displayed after
the “Attach” button has
been clicked.

If Schedule I or
Schedule F
attachment, go back
to Filing Summary
(Screen 11).

If Schedule P attachment
then go to Schedule P
Summary (Screen 34).

Show appropriate Schedule depending on appropriate “Comments” button from Screen 11 on
Screen 34.

SCREEN 41

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Schedule G/FG/I/F/P – Comments
Comments:
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SCREEN 42
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Reassign Filing
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here

Enter the email address of the person you would like to assign this filing:
Email address:

(ex. aa@a.com)

Note: You may only assign a filing to someone who
has an e-4010 account.
Cancel

Assign

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This button will first check that the
entered email is associated with an
existing e-4010 account. If not,
display error message. If account with
the entered email exists, then assign
this filing to the new filing coordinator
and return to screen 8.

SCREEN 43
Help

Assign to Actuary
Controlled Group: ABC Holdings, Inc.
Error messages (EM##) shown here
This drop-down list will be
populated with the first name, last
name, and email addresses of
those actuaries already assigned by
the current FC.

Actuaries currently assigned:
Enter the email address of the actuary you would like to assign this filing:
Email address:

(ex. aa@a.com)

Note: You may only assign an actuary who has an
e-4010 account.
Cancel

Assign

PBGC.gov | Paperwork Reduction Act Notice
This button will first check that the
entered email is associated with an
existing e-4010 account. If not,
display error message. If account with
the entered email exists, then assign
this schedule P to the actuary and
return to screen 21.

SCREEN 44

Paperwork Reduction Act Notice
The PBGC needs this information, which is required to be submitted under part 4010, to enable it (1) to detect
and monitor financial problems with the contributing sponsors that maintain severely underfunded pension
plans and their controlled group members, (2) to respond quickly when it learns that a controlled group with
severely underfunded pension plans intends to engage in a transaction that may significantly reduce the
assets available to pay plan liabilities, and (3) to take action to protect participant and premium-payer
interests.
The information provided to the PBGC under part 4010 is protected from disclosure as provided in 29 CFR §
4010.12. That section provides that in accordance with 29 CFR § 4901.21(a)(3) (part of the PBGC's
regulation on Examination and Copying of PBGC Records) and section 4010(c) of ERISA, any information or
documentary material that is not publicly available and is submitted to the PBGC pursuant to part 4010 shall
not be made public, except as may be relevant to any administrative or judicial action or proceeding or for
disclosures to either body of Congress or to any duly authorized committee or subcommittee of the Congress.
The PBGC estimates that the average annual burden of this collection of information is 8.7 hours and
$13,750 per controlled group. These are estimates and the actual time will vary depending on the
circumstances of a given filing. If you have any comments concerning the accuracy of these burden
estimates or suggestions for making it simpler to submit the information, please send your comments to the
Pension Benefit Guaranty Corporation, Office of the General Counsel, 1200 K Street, N.W., Washington, D.C.
20005-4026.
This collection of information has been approved by the Office of Management and Budget (OMB) under
control number 1212-0049 (expires February 29, 2008). Under the Paperwork Reduction Act, an agency may
not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a currently valid OMB control number.
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SCREEN 45

Privacy Policy
Thank you for visiting the Pension Benefit Guaranty Corporation (PBGC) Web site. You are accessing a computer system operated by PBGC, a
wholly-owned corporation of the United States Government.
PBGC is committed to protecting the privacy of individuals using our Web site. As a general rule, PBGC does not collect personal identifying
information during a visit to the PBGC Web site, except when you choose to provide such information to us, or when you use one of PBGC's
online customer self-service applications.
PBGC does collect certain non-personal information for system management and site security purposes.

Non-Personal Information We Collect
System Management: As part of system management, PBGC uses various software tools and computing methods to insure this site is
operating in an optimum manner and to identify what information is of the most and least interest to its users. We do not collect or sell
information about you for commercial purposes. Among the information that currently is collected by PBGC for system management are:
The name of the domain from which you access the Internet;
The type of browser and operating system used to access our site;
The date and time you access our site;
The Internet address of the Web site from which linked directly to our site; and,
The pages and files you access on this site.
Please note that none of this information identifies you personally in any way.
Site Security: For security purposes and to ensure that this service remains available to all users, PBGC also employs software programs to
monitor network traffic to identify unauthorized attempts to upload or change information, or otherwise cause damage. No attempts are made to
identify individual users unless that user chooses to submit personal information, or illegal behavior is suspected. Unauthorized attempts to
upload information or change information on this service are strictly prohibited and may be punishable under the Computer Fraud and Abuse Act
of 1986, the National Information Infrastructure Protection Act of 1996, or other such laws as may apply.
Cookies: Cookies are small data files sent to your computer by Web sites you visit. Cookies store information about you and the type of
computer you use to access the Web site. These files may contain personal information. There are two types of cookies: session and persistent.
Session cookies expire once the user closes the browser. Persistent cookies, however, remain on your system for an extended period of time.
In accordance with federal policy, PBGC does not use persistent cookies on its Web site.
The e-4010 application on the Web site uses session cookies to recognize you and assist you in navigating the application in the most efficient
and effective manner possible. You must accept these session cookies if you wish to use the e-4010 application. As stated above, session
cookies expire once you close your browser. No information about you is maintained as a result of a session cookie.

Personal Identifying Information That You Submit
e-4010: PBGC receives and stores personal identifying information submitted by you within the e-4010 application on the Web site (located at
www.pbgc.gov/e4010). This information (name, work address, telephone number, and e-mail address) is used to establish your account,
respond to your requests, and provide you with information about your interactions with PBGC. The security of the information you input for e4010 is protected during transmission using Secure Sockets Layer (SSL) encrypting software. By providing PBGC with your email address, it will
be used by PBGC to contact you regarding your account status (including confirmation of registration), and may be used to contact you for other
purposes (for example, to notify you about major changes to the Web site or to request feedback on the application.
Storage of Information: To prevent unauthorized access, maintain data accuracy, and ensure the appropriate use of information, PBGC has
put in place physical, electronic, and managerial procedures to protect the personal identifying and other information collected online. PBGC will
keep a log of all transactions and data that you submit via the e-4010 application in order to (1) provide efficient customer service; (2) to provide
adequate audit records, and (3) to process your data transactions or requests. Your information will be maintained and managed in accordance
with the Federal Records Act.
PBGC may disclose information you submit if we are required to do so by law or we in good faith believe that such action is necessary to: (1)
comply with the law or with legal process; (2) protect and defend our rights and property; (3) protect against misuse or unauthorized use of e4010; or (4) protect the personal safety or property of our users or the public. If you provide false information, attempt to pose as someone else,
or otherwise are believed to have committed any other illegal act, information about you may be disclosed as part of any investigation into your
actions).
Email: If you contact PBGC via electronic mail rather than through the secure e-4010 application, the information you send will still be used for
the purposes described at the point of collection and stored as record material. However due to the nature of the Internet and the World Wide
Web, we cannot assure the security of the information during transmission by electronic mail over the public Internet. Thus, you may be
uncomfortable with sending sensitive information (such as a bank account number or your home phone number and address) to PBGC other
than through the secure e-4010 application. As an alternative, we suggest that you (1) contact PBGC by telephone or (2) send the information to
PBGC by regular mail. See Contact Information under www.pbgc.gov for appropriate addresses and telephone numbers.

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File Typeapplication/pdfFile TitleVisio-4010_Wireframes_v3.vsdAuthordoecma16File Modified2005-12-13File Created2005-12-13
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