OMB
.report
Search
Pension Benefit Statement
Pension Benefit Statement
OMB: 1210-0166
IC ID: 242407
OMB.report
DOL/EBSA
OMB 1210-0166
ICR 202006-1210-001
IC 242407
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0166 can be found here:
2024-08-16 - Extension without change of a currently approved collection
2021-09-17 - New collection (Request for a new OMB Control Number)
Documents and Forms
Document Name
Document Type
Lifetime APPENDIX I-II-07-21-2020-clean.docx
Other-Model
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Pension Benefit Statement
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
29 CFR 2520
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Model
Lifetime APPENDIX I-II-07-21-2020-clean.docx
Yes
Yes
Printable Only
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:
709,527
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
92 %
Requested
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
397,933,333
0
397,933,333
0
0
0
Annual IC Time Burden (Hours)
19,253
0
19,253
0
0
0
Annual IC Cost Burden (Dollars)
497,108,843
0
497,108,843
0
0
0
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.