Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0049 can be found here:

Documents and Forms

Document Name Document Type
Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) Form
Appendix 2 - Instructions.doc Instruction
Appendix 2 - PPA Form.pdf Instruction
Overview.pdf Other-Overview
4010 screen shots (pre-PPA) Appendix 1 - Screen Shots.pdf Form and Instruction
4010 (pre-PPA) Appendix 3 - Form.doc Form
4010 (PPA) Appendix 1 - PPA Form.pdf Form
4010 Screenshots (PPA) Appendix 3 - PPA Screenshots.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Financial and Actuarial Information Reporting (29 CFR Part 4010)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	4010 (pre-PPA)	Appendix 3 - Form.doc	Yes	Yes	Fillable Fileable Signable
Form	N/A	4010 (PPA)	Appendix 1 - PPA Form.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			Appendix 2 - PPA Form.pdf	Yes	Yes	Fillable Fileable Signable
Other-Overview			Overview.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	N/A	4010 Screenshots (PPA)	Appendix 3 - PPA Screenshots.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	NA	4010 screen shots (pre-PPA)	Appendix 1 - Screen Shots.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			Appendix 2 - Instructions.doc	Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	300	-100	400
Annual IC Time Burden (Hours)	2,600	-880	3,480
Annual IC Cost Burden (Dollars)	5,167,500	-332,500	5,500,000

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.