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ERISA Summary Annual Report Requirement
Employee Retirement Income Security Act Summary Annual Report Requirement
OMB: 1210-0040
IC ID: 13341
OMB.report
DOL/EBSA
OMB 1210-0040
ICR 201902-1210-008
IC 13341
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0040 can be found here:
2023-07-05 - No material or nonsubstantive change to a currently approved collection
2023-02-24 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Model Summary Annual Report Relating to Pension Plans.docx
Other-Model Form for Pension Plans
Model Summary Annual Report Relating to Welfare Plans.docx
Other-Model Form for Welfare Plans
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
ERISA Summary Annual Report Requirement
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
29 CFR 2520.104(b)-1(c)
29 CFR 2520.104b-10
29 CFR 2520.104(b)-1(b)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Model Form for Pension Plans
Model Summary Annual Report Relating to Pension Plans.docx
Yes
No
Fillable Printable
Other-Model Form for Welfare Plans
Model Summary Annual Report Relating to Welfare Plans.docx
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
743,628
Number of Respondents for Small Entity:
624,435
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
56 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
170,628,651
0
0
2,428,651
0
168,200,000
Annual IC Time Burden (Hours)
1,817,006
0
0
-482,994
0
2,300,000
Annual IC Cost Burden (Dollars)
49,223,676
0
0
-13,276,324
0
62,500,000
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.