e-4010 Screenshots

Sreenshots

Appendix 3
Screen 1

Account Sign-Up
Error messages shown here
First name:
Last name:
Company:
Title:
Work address:

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

(ex. 22222-2222)
Ext.

Email address:
Confirm email address:
Secret question:
Secret Answer:

PBGC.gov | Paperwork Reduction Act Notice
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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?

Updated March 26, 2013

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Appendix 3
Screen 2

Log in
Error messages 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?

Already Have an Account? Log in.
User ID:
Password:

Forgot your User ID?
Forgot your password?

PBGC.gov | Paperwork Reduction Act Notice | Privacy Policy
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Clicking “Apply for an Account” displays Screen 1.
Clicking “Login”; If first time logging in, goes to Screen 3, else goes to screen 9.

Updated March 26, 2013

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Appendix 3
Screen 3.
Help.

First Time Login..
Error messages 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:

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The Secret question 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?
Clicking “Cancel” goes to Back to Login Page (Screen 2)
Clicking “Save” goes to the Home page (Screen 9)

Updated March 26, 2013

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Appendix 3
Screen 4

Forgot/Reset Password
Error messages shown here
Email Address:

(ex. aa@a.com)

Secret Question
Secret Answer

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The 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?

Updated March 26, 2013

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Appendix 3
Screen 5

Forgot User ID
Error messages shown here
Email Address:

(ex. aa@a.com)

Secret Question
Secret Answer

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The 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?

Updated March 26, 2013

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Appendix 3
Screen 6

Change Password
Error messages shown here
New Password:
Confirm Password:
Secret Question
Secret Answer

In what city were you born?

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

Updated March 26, 2013

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Appendix 3
Screen 7.
Help.

Change Temporary Password.
Error messages 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:

PBGC.gov | Paperwork Reduction Act Notice.
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The Secret question 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?

Updated March 26, 2013

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Appendix 3
Screen 8

Manage Account
Error messages shown here
First name:
Last name:
Company:
Title:
Work address:

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

(ex. 22222-2222)

Ext.

Email address:
Confirm email address:
Secret question: In what city were you born?
Secret Answer:

PBGC.gov | Paperwork Reduction Act Notice

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 9

Manage Account | Change Password | Logout| Help

e-4010 Home Page
Controlled Group Filing Drafts
Information
Year-end

Date
Created

Name

12/31/2005

04/04/2006

ABC Holdings, Inc.

12/31/2005

04/09/2006

XYZ Holdings, Inc.

Controlled Group Filings Submitted to PBGC
Information
Year-end

Original
Submission
Date

12/31/2005

04/15/2006

Amended
Submission
Date
01/15/2006

Name
JKL Holdings, Inc.

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The Create New 4010 Filing button goes to screen 10 and initiates a new 4010 filing.
If user is the Filing Coordinator for this filing, the first button under the Controlled Group Filing
Drafts headings will be labeled “Edit Filing” and will take the user to the Filing Summary (Screen
12). 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.
The delete button will only appear if the user is a Filing Coordinator for the filing. It will delete a
4010 filing in process.
The Reassign button will only appear if the user is a Filing Coordinator for the filing. It goes to
screen 49 to assign this filing to a new coordinator.
If user is the Filing Coordinator for a filing in the Controlled Group Filings Submitted to PBGC
section, the first button under the headers in this section will be labeled “View Filing" and the
printable format of the filing will be displayed when the button is clicked. 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 when the button is clicked.
The View Attachment button allows user to view any/ all attachments attached to this filing.
The Amend Filing 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 12).

Updated March 26, 2013

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Appendix 3
Screen 10

E-4010 – Create New Filing
Error messages shown here
Select option for new filing
Pre-populate with data from previously submitted filing
Do not pre-populate

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When next is clicked, If answer is to “pre-populate”, go to screen 11. If answer is “do not prepopulate”, go to Schedule G (screen 13).
When cancel is clicked, go to Home Page (Screen 9)

Updated March 26, 2013

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Appendix 3
Screen 11

E-4010 – Create New Filing
Error messages shown here
Select the prior filing from which data will
be extracted to pre-populate the new filing:
Drop down list of past filings.

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When next is clicked, go to pre-populated Schedule G (screen 13).
When cancel is clicked, go to Home Page (Screen 9)

Updated March 26, 2013

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Appendix 3
Screen 12

This screen shown if existing filing is clicked from Home Page, or after a filing is deemed necessary in Schedule
FG.

Manage Account | Change Password | Logout | Help

Filing Summary.
Controlled Group: ABC Holdings, Inc.
Schedules.
Schedule G goes to Screen 13.
Schedule FG goes to Screen 14.
Schedule I
Section I (Member Information) goes to Screen 21.
Section II (Plan Information) goes to Screen 24.
Section III (Prior member/plan information)
Schedule F
Schedule P goes to Screen 39.

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The Section III link goes to Screen 31 (Will show message that this section is not required if no
changes were made from last year.)
The schedule F link goes to Screen 32 if first time through; to Screen 33 if
“Consolidated/Individual not yet indicated OR if “Combined” and a new, non-exempt plan has
been added. Otherwise, goes to Screen 34.
Clicking the ‘Comments’ button goes to Screen 48.
Clicking the ‘Attachment’ button goes to Screen 47.
Clicking the ‘e-4010 Home Page’ button goes to Screen 9.
Clicking the ‘Validate Filing’ button will display a page that contains a summary of all the missing
information that is needed for submission to PBGC.
Clicking the ‘View Draft’ button will display a page that contains a summary of the filing
information entered thus far.
Clicking the ‘Submit Filing’ button sets status of filing to “Submitted”. Validations are performed to
ensure that filing is complete. If validated, then the filling is marked as submitted. At this time, it
is no longer editable, and you can now print the form as a receipt. This filing will also appear on
the lower section of the homepage under the “Controlled Group Filings Submitted to PBGC”
section.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 13

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

Schedule G – General Information.
Error messages shown here.
Controlled Group Information.
Name:
Business Code:
CUSIP number:
Date current information
year ends:

(ex. 111111)
(enter first 6 digits only)
(ex. MM/DD/YYYY)

Filing Contact.
General contact
information:

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

No

Is a 4010 filing required this year?
Yes

No

Help me determine

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

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Condition 1: If answer is “No” to both questions, display message indicating that a filing does not
need to be submitted.
Condition 2: If choose “Help Me Determine,” display Schedule FG to test need.
Condition 3: 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.
Condition 4: If “Yes,” to second question, Schedule FG can be bypassed; display message that a
4010 filing is required.
Cancel takes the user back to the Home Page (Screen 9)
If ‘Next ‘ is clicked: If Condition 1, go to Screen 20; if Condition 2 OR 3 go to Screen 14; if
Condition 4, go to Screen 18.

Updated March 26, 2013

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Appendix 3
Screen 14.

Schedule FG – Filing Gateway
Controlled Group: ABC Holdings, Inc.
Error messages shown here.
1. §4010.4(a)(1) - 4010 Funding target attainment percentage
Did any plan sponsored by a member of the controlled group have a 4010 funding target
attainment percentage below 80%?
Yes

No

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Cancel takes the user back to the Filing Summary (Screen 12)
If ‘Next ‘ is clicked: If the answer was “Yes”, go to Screen 15 (which is part 2 of question 1). If
“No” go to Screen 16.

Updated March 26, 2013

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Appendix 3
Screen 15.

Schedule FG – Filing Gateway
Controlled Group: ABC Holdings, Inc. .
Error messages shown here.
1. §4010.4(a)(1) - 4010 Funding target attainment percentage
Does the total amount of 4010 funding shortfall in plans (including exempt plans) maintained by
the members of the contributing sponsor's controlled group exceed $15 million (disregarding those
plans with no 4010 funding shortfall)?
Yes

No

PBGC.gov | Paperwork Reduction Act Notice.
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Cancel takes the user back to the Filing Summary (Screen 12)
If ‘Next ‘ is clicked: If “Yes” go to message indicating a Filing is required (Screen 18). If “No” go to
Screen 16.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 16.

Schedule FG – Filing Gateway
Controlled Group: ABC Holdings, Inc. .
Error messages 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
•
Yes

as a result of the missed contribution, the conditions for imposition of a lien under ERISA
have been met?
No

PBGC.gov | Paperwork Reduction Act Notice.
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Cancel takes the user back to the Filing Summary (Screen 12)
If ‘Next ‘ is clicked: If “Yes” go to message indicating a Filing is required (Screen 16a). If “No”
AND the information year begins 12/31/2007 or before, go to Screen 15. If “No” AND the
information year begins 1/1/2008 or later, go to Screen 15a.

Updated March 26, 2013

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Appendix 3
Screen 17.

Schedule FG – Filing Gateway.
Controlled Group: ABC Holdings, Inc. .
Error messages 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
•

Yes

for which there is an outstanding balance at the end of the plan year ending within the
information year (determined in accordance with § 1.4010.4(e))?
No

PBGC.gov | Paperwork Reduction Act Notice.
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Cancel takes the user back to the Filing Summary (Screen 12)
If ‘Next ‘ is clicked: If “Yes”, display message indicating a Filing is required (Screen 18). If “No”,
and a filing was required last year, display message indicating that only Schedule FG needs to be
submitted (Screen 19). If “No”, and a filing was not required last year, display message indicating
that a filing does not need to be submitted (Screen 20).

Second bullet under question 3 was reworded for Version 3.0 - only applies to 2008
and later filings

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 18.

ERISA 4010 Filing Required.
Controlled Group: ABC Holdings, Inc. .
Error messages 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.

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Clicking “Go to Filing Summary Page” takes the user to Screen 12

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 19.

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

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Clicking “Go to Filing Summary Page” takes the user to Screen 12

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 20.

No ERISA 4010 Filing Required.
Controlled Group: ABC Holdings, Inc. .
Error messages shown here.
Based on the information you have entered, you do not have to submit a filing to PBGC.

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Go to e-4010 Home Page” takes the user to Screen 9.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 21.

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

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

ABC Manufacturing, Inc.

10-7894562

ABC Distribution, Inc.

10-7894563

ABC Technologies Corp.

10-7894564

ABC Enterprises, Inc.

10-7894565

ABC Healthcare, LLP

10-7894566

ABC Resources, Inc.

10-7894567

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Clicking “Enter Member Company” Displays Screen 12
Clicking “Delete” Deletes the Member
Clicking “Back to Filing Summary” Displays Screen 12

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 22.

Help.

Schedule I - Identifying Information.
Section I - Controlled Group Members.
Controlled Group: ABC Holdings, Inc. .
Error messages shown here.
Company name:
EIN:
Address:

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

(ex. 22222-2222)

Telephone:

Ext.

Relationship:
Check box if this is an exempt member of the
Controlled Group that sponsors an exempt plan:
PBGC.gov | Paperwork Reduction Act Notice
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Updated March 26, 2013

Clicking “Cancel” displays Screen 12.
Clicking “Next” displays Screen 23.

Sreenshots

Appendix 3
Screen 23.

Help.

Schedule I - Identifying Information.
Section I - Controlled Group Members.
Controlled Group: ABC Holdings, Inc. .
Member: ABC Financials, Inc..
Error messages 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

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” displays Screen 21, data is not saved.
Clicking “Save” displays Screen 21.
Clicking “Enter Next Member” displays Screen 22.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 24.

Manage Account | Change Password | Logout | Help

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

EIN/PN.

Schedule P
Requirement
Waived?*

Plan A.

ABC Financials Inc. .

10-7894561/001.

No.

Plan B.

ABC Financials Inc. .

10-7894561/002.

No.

Plan C.

ABC Textiles, Inc. .

10-7894563/001.

No.

Plan D.

ABC Wheels, Inc. .

10-7894564/001.

Yes.

Plan Name.

* A yes in this column indicated that a Schedule P (Plan Actuarial Information) does not need to be
included with this filing. This is the case if the plan is an exempt plan or if the plan is a multiple employer
plan and:
-

Another sponsor of the multiple is proving the relevant actuarial information, and

-

This filing includes information on that other sponsor in the Schedule I comment box.

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The Asterisk in the “Schedule P Requirement Waived?” column and its related footnote are
displayed only if at least one plan in the list is a multiple employer plan.
Clicking the “Enter Plan” button displays Screen 25 (enter new).
Clicking “Modify Member Information” displays Screen 21.
Clicking “Back to Filing Summary” displays Screen 12.
As users enter new plans, they appear in this list.
The “plan name” hyperlinks will open Screen 25 with the data pre-populated for further editing if
necessary.
The Actuary buttons will only appear next to plans that were designated not-exempt (on Screen
25).
If assigning actuary, go to screen 50.
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 screen 39),
the label will revert to “Assign to Actuary”.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 25.

Help.

Schedule I - Identifying Information.
Section II- Plans.
Controlled Group: ABC Holdings, Inc. .
Error messages shown here.
Information for current year.
Plan name:
Plan sponsor:
Plan number (PN):
Is this plan a multiple employer plan?
Yes

No

Is the requirement to submit actuarial information waived either because the plan is an exempt plan
(as defined by § 1.4010.8(c)) or because the actuarial information is being reported by another filer (in
accordance with § 1.4010.8(f))?
Yes

No

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

No

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The Plan sponsor drop down list includes a list of members from Screen 21 (Schedule I.I) – the
list will be formatted as “Member Name/EIN”.
Clicking “Enter New Member” displays Screen 21 (Schedule I.I entry page).
All plans that answer “No” to the second question will show up on the Schedule P Summary
(Screen 39).
Clicking “Cancel” goes back to Schedule I, Section II Summary (Screen 24).
Clicking “Next” will: If frozen, display screen 26; If not frozen display 27.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 26.

Help.

Schedule I - Identifying Information.
Section II- Plans.
Controlled Group: ABC Holdings, Inc. .
Member: ABC Financials, Inc.
Plan: Plan A
Error messages 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:

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 24 (no save).
Clicking “Next” displays Screen 27.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 27.

Help.

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

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 24 (no save).
Clicking “Next” - depends on answer on this page: If “Yes”, will require that Screen 29 be
displayed; If “No”, then finished with this plan, go to Screen 28; If “N/A”, will require that screen 30
be displayed.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 28.

Help.

Schedule I - Identifying Information.
Section II- Plans.
Controlled Group: ABC Holdings, Inc. .
Member: ABC Financials, Inc. .
Plan: Plan B…
Plan Information Completed
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.

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 24 (no save).
Clicking “Save” goes back to Screen 24.
Clicking “Enter Next Plan” goes back to Screen 25.

Updated March 26, 2013

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Appendix 3
Screen 29.

This page displayed if changes were made since the beginning of the year (“Yes” to the question on Screen 27)

Help.

Schedule I - Identifying Information.
Section II- Plans.
Controlled Group: ABC Holdings, Inc. .
Member: ABC Financials, Inc. .
Plan: Plan A …
Error messages shown here.
Information on changes in EIN/PN
Prior EIN:

(ex. 11-1111111)

Prior PN:

(ex. 333)

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 24 (no save).
Clicking “Save” goes back to Screen 24.
Clicking “Enter Next Plan” goes back to Screen 25.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 30.

This screen will appear only if “N/A (new plan)” was selected on Screen 27.

Help.

Schedule I - Identifying Information.
Section II- Plans.
Controlled Group: ABC Holdings, Inc. .
Member: ABC Financials, Inc. .
Plan: Plan B …
Error messages 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:

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 24 (no save).
Clicking “Save” goes back to Screen 24.
Clicking “Enter Next Plan” goes back to Screen 25.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 31.

Help.

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

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).

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 12 (no save).
Clicking “Save” goes back to Screen 12.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 32.

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 34.

Help.

Schedule F - Financial Information.
Type of Submission.
Controlled Group: ABC Holdings, Inc. .
Error messages shown here.

Which of the permissible filing alternatives is being used?
§4010.9(a) - separate financial information (financial statements or tax returns) for each nonexempt controlled group member will be provided.
§4010.9(b) - consolidated financial information that includes combined information for all nonexempt 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 nonexempt members whose information is not included in the consolidated information.

PBGC.gov | Paperwork Reduction Act Notice.
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If all are separate or all are consolidated, will not need Screen 33; go to Screen 34. If there are
some individual and some consolidated, Screen 33 will be displayed next.
Clicking “Cancel” goes back to Screen 34 (no save).
Clicking “Next” goes to Screen 33 or 34.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 33.

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

Help.

Schedule F - Financial 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.

PBGC.gov | Paperwork Reduction Act Notice.
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Show only those members that were marked as “non-exempt” on Schedule I.I (last question on
Screen 10)
Clicking “Cancel” goes back to Screen 34 (no save).
Clicking “Save” goes to Screen 34.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 34.

Manage Account | Change Password | Logout | Help.

Schedule F - Financial Information - Summary.
Controlled Group: ABC Holdings, Inc. .

Consolidated Members.
Member Company.

EIN.

ABC Holdings, Inc..
ABC Distribution, Inc. .

10-7894561. .
10-7894563.

Individually Listed Members.
Member Company.
EIN.

Complete.
Yes…
No…

Complete.

ABC Manufacturing, Inc.

10-7894562. .

Yes…

ABC Distribution, Inc. .

10-7894564..

No…

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These tables display all members on Schedule I.I
Clicking “Edit” goes to Screen 35.
Clicking “Modify Member Information” goes to Screen 21.
Clicking “Back to Filing Summary” goes to Screen 12.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 35

Help.

Schedule F - Financial Information .
Controlled Group: ABC Holdings, Inc. .
Member: ABC Distribution, Inc. .
Error messages shown here.
Reporting Method.
What type of information is being reported?
Audited financial statements.
Unaudited financial statements.
Federal tax returns.

PBGC.gov | Paperwork Reduction Act Notice.
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The header line displays either “Consolidated” or “Member: Plan Name”.
Clicking Cancel” goes back to Screen 34 (no save)
Clicking “Next” goes to Screen 36.

Updated March 26, 2013

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Appendix 3
Screen 36.

Help.

Schedule F - Financial Information .
Controlled Group: ABC Holdings, Inc. .
Member: ABC Distribution, Inc. .
Error messages shown here.
Reporting Method.
Will financial information be attached to this filing?
Will consolidated financial information be attached to this filing?
Yes.
No, because it is publicly available.

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The header line displays either “Consolidated” or “Member: Plan Name”.
If individually submitting financial information, first question is displayed.
If consolidated financial information, second question is displayed.
Selecting ‘No’ will require that Screen 37 be displayed.
Clicking Cancel” goes back to Screen 34 (no save).
Clicking “Next” goes to Screen 37 if information is publicly available. If not, and is for
consolidated, goes to Screen 33. If not and individual, displays message indicating that Schedule
F is complete.

Updated March 26, 2013

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Appendix 3
Screen 37.

Help.

Schedule F - Financial Information .
Controlled Group: ABC Holdings, Inc. .
Member: ABC Distribution, Inc. .
Error messages 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)

PBGC.gov | Paperwork Reduction Act Notice.
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The header line displays either “Consolidated” or “Member: Plan Name”.
Clicking “Cancel” goes back to Screen 29 (no save).
Clicking “Next” - if consolidated, goes to Screen 38. If individual, displays message indicating
that Schedule F is complete.

Updated March 26, 2013

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Appendix 3
Screen 38.

Help.

Schedule F - Financial Information .
Controlled Group: ABC Holdings, Inc. .
Consolidated .
Error messages 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: $
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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The header line displays either “Consolidated” or “Member: Plan Name”.
Lists out each member that is indicated as “Consolidated” on Screen 34 of Schedule F..
Clicking “Cancel” goes back to Screen 34 (no save).
Clicking “Save” goes back to Schedule F Summary (Screen 34).

Updated March 26, 2013

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Appendix 3
Screen 39.

Manage Account | Change Password | Logout | Help..

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

Sponsor.

EIN/PN.

Complete?

Plan A,

ABC Holdings Inc.

10-7894561/001.

“Y”,

Plan B,

ABC Holdings Inc..

10-7894561/002

“N“,

Plan C,

ABC Technologies, Inc. .

10-7894563/001.

“N”,

Plan D,

ABC Distribution, Inc..

10-7894564/001

“N“,

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Clicking “Comments” goes to Screen 48.
Clicking “Attachments” goes to Screen 47.
Plan Name hyperlinks to: Screen 40 (pre-populated if already filled out). Displays only those plans
that were marked as “non-exempt” on Schedule I.II (Screen 24).
Clicking “Back to Members” goes to Screen 21.
Clicking the “Print Schedule P Certification” buttons will open this plan's Schedule P for printing.
Clicking “Back to Plans” goes to Screen 24.
The “Notify FC” buttons will only appear if this schedule P has been assigned to an actuary. When
clicked, 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.
Clicking “Back to Filing Summary” goes back to Screen 12.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 40.

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 shown here.
Enrolled Actuary Information.
First name:
Last name:
EA number :
Telephone:

(ex. 02-1111)

Ext.

Email address (optional):

(ex. aa@a.com)

Enter the following information with respect to the plan year ending within the information year.
Date plan year begins:

(ex. MM/DD/YYYY)

Date plan year ends:

(ex. MM/DD/YYYY)

Is this plan year a short plan year?
Yes.

No…

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 39.
Clicking “Next” goes to Screen 41

Updated March 26, 2013

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Appendix 3
Screen 41.

Help..

Schedule P – Plan Actuarial Information .
Funded Status Information (§4044 basis)
Controlled Group: ABC Holdings, Inc. .
Plan Sponsor: ABC Financials, Inc..
Plan Name: Plan A: 10-7894562/001.
Error messages shown here.
Participant Counts and Benefit Liabilities.
Participant Status.

Number of Participants.

Benefit Liabilities
at plan year-end
(Before reflecting expense load) .

Active.

###,###

$

###,###,###

Terminated vested.

###,###

$

###,###,###

.Receiving benefits.

###,###

$

###,###,###

Total.

_______________

__________________

###,###

$ ###,###,###

Benefit Liabilities after reflecting expense load.
Expense load per § 4044.52(d) .

$

Total Benefit Liabilities*.

$

###,###,###

###,###,###

* Determined using retirement age, interest, mortality, expense load provided in § 4044.51-57 and other
assumptions as provided in § 4010.8(d)(2).

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Clicking “Calculate Totals” will calculate and display total benefit liabilities before and after expense
load as been factored in.
Clicking “Cancel” goes back to Screen 39.
Clicking “Next” goes to Screen 42.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 42.

Help..

Schedule P – Plan Actuarial Information .
Funded Status Information (§4044 basis)
Controlled Group: ABC Holdings, Inc. .
Plan Sponsor: ABC Financials, Inc..
Plan Name: Plan A: 10-7894562/001.
Error messages 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.
Period 1:

% for first

Period 2:

% for all years thereafter.

Years (ex. 4.21% for first 20 years).

Fair market value of assets (excluding receivables) at plan year-end:

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 39.
Clicking “Next” goes to Screen 43.

Updated March 26, 2013

$

###,###,###

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Appendix 3
Screen 43.

Help..

Schedule P – Plan Actuarial Information .
Other Information .
Controlled Group: ABC Holdings, Inc. .
Plan Sponsor: ABC Financials, Inc..
Plan Name: Plan A: 10-7894562/001.
Error messages shown here.
The following items relate to the 1/1/2008 – 12/31/2008 plan year:
Funding target (as of the valuation date) determined as if the plan has been
in at-risk status for a consecutive period of at least 5 plan years:

$

###,###,###

Funding target attainment percentage (as of valuation date):

% (ex. 92.21)

Adjusted funding target attainment percentage (as of valuation date):

% (ex. 92.21)

Did any benefit limitations apply under ERISA 206(g) at any time during the
plan year?

Yes.

No…

Has one or more minimum funding waivers been granted totaling in excess
of $1 million for which there is an outstanding balance at the end of the plan
year?

Yes.

No…

Yes.

No…

The following item relates to the information year ending 12/31/2008:
Has a statutory lien arisen during the information year as the result of
missed contributions in excess of $1 million (that were not made within 10
days of the due date)?

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The first set of dates listed are those for “Date plan year begins” and “Date plan year ends” entered
by user on an earlier Schedule P screen (Screen 40).
The second date listed is that for “Date current information year ends” entered by user on the
Schedule G (screen 13).
Clicking “Cancel” goes back to Screen 39.
Clicking “Next” : If the answer to the benefit limitations question is “Yes, goes to Screen 44. If No,
goes to Screen 45.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 44.

Help..

Schedule P – Plan Actuarial Information .
Other Information .
Controlled Group: ABC Holdings, Inc. .
Plan Sponsor: ABC Financials, Inc..
Plan Name: Plan A: 10-7894562/001.
Error messages shown here.
Benefit limitations explanation.
Enter required information with respect to the benefit limitations applied
under ERISA 206(g) (see instructions).

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 39.
Clicking “Next” goes to Screen 45.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 45.

Help..

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 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.

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 39 (no save).
Clicking “Next” goes to Screen 46.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 46.

Help..

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.

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking “Cancel” goes back to Screen 39 (no save).
Clicking “Save” goes to Screen 39.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 47.

Help..

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

Description.

org_chart1.pdf,,,

org chart for the controlled group.

sal_avg.doc…

valuation report for the salaried plan.

File:

Description:

It may take a minute or two to attach large files. Please click only once.

PBGC.gov | Paperwork Reduction Act Notice.
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This screen shows the appropriate Schedule depending on button clicked on Filing Summary
(Screen 12) or Schedule P Summary (Screen 39).
Files are displayed after the “Attach” button has been clicked.
If Schedule I or Schedule F attachment, click the “Back to Filing Summary” button to go back to
Filing Summary (Screen 12).
If Schedule P attachment, click the “go to Schedule P Summary” button to go to Schedule P
Summary (Screen 39).

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 48.

Help..

Schedule G/FG/I/F/P – Comments .
Comments:

PBGC.gov | Paperwork Reduction Act Notice.
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This screen shows the appropriate Schedule depending on appropriate “Comments” button from
Screen 12 on Screen 39.
Clicking “Cancel” goes back to Screen 12 (no save).
Clicking “Save” goes back to Screen 12.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 49.

Help..

Reassign Filing .
Controlled Group: ABC Holdings, Inc. .
Error messages 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.

PBGC.gov | Paperwork Reduction Act Notice.
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Clicking the “Next” button will first check that the entered email is associated with an existing e-4010
account and If not, display an error message. If account with the entered email exists, then the
system assigns this filing to the new filing coordinator and returns to screen 9.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 50.

Help..

Assign to Actuary .
Controlled Group: ABC Holdings, Inc. .
Error messages shown here.
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.

PBGC.gov | Paperwork Reduction Act Notice.
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The drop-down list will be populated with the first name, last name, and email addresses of those
actuaries already assigned by the current FC.
Clicking the “Assign” button will first check that the entered email is associated with an existing e4010 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 39.

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 51.

Help..

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.
Close Window

Updated March 26, 2013

Sreenshots

Appendix 3
Screen 52.

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 e-4010 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 e-4010; 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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Updated March 26, 2013