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Reportable Events
Reportable Events
OMB: 1212-0013
IC ID: 13522
OMB.report
PBGC
OMB 1212-0013
ICR 202106-1212-001
IC 13522
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0013 can be found here:
2024-04-10 - Revision of a currently approved collection
2023-10-20 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form Form 10
Reportable Events
Form
Form-10-Instructions_Revised_Clean.docx
Instruction
Form-10-Instructions_Revised_Clean.docx
Instruction
Form-10-AdvanceInstructions_Revised_Clean.docx
Instruction
Form-10-AdvanceInstructions_Revised_Clean.docx
Instruction
4043 screenshots_Revised April 2021.docx
Other-Screen shots
4043 screenshots_Revised April 2021.docx
Other-Screen shots
Form 10 Post-Event Notice of Reportable Events
Form-10_Revised_Clean.docx
Form
Form 10 Post-Event Notice of Reportable Events
Form-10_Revised_Clean.docx
Form
Form 10-Advance Advance Notice of Reportable Events
Form-10-Advance.docx
Form
Form 10-Advance Advance Notice of Reportable Events
Form-10-Advance.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Reportable Events
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
29 CFR 4043
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
Form 10
Post-Event Notice of Reportable Events
Form-10_Revised_Clean.docx
Yes
Yes
Fillable Fileable Signable
Instruction
Form-10-Instructions_Revised_Clean.docx
Yes
Yes
Fillable Fileable Signable
Form
Form 10-Advance
Advance Notice of Reportable Events
Form-10-Advance.docx
Yes
Yes
Fillable Fileable Signable
Instruction
Form-10-AdvanceInstructions_Revised_Clean.docx
Yes
Yes
Fillable Fileable Signable
Other-Screen shots
4043 screenshots_Revised April 2021.docx
Yes
Yes
Fillable Fileable Signable
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:
573
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:
100 %
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
573
0
0
51
0
522
Annual IC Time Burden (Hours)
1,802
0
0
161
0
1,641
Annual IC Cost Burden (Dollars)
426,885
0
0
37,995
0
388,890
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.