This form is used by a plan
administrator or plan sponsor of a plan to request that the Pension
Benefit Guaranty Corporation determine whether a plan is covered
under title IV of the Employee Retirement Income Security Act of
1974.
The changes to the estimates of
hour and cost burdens of this collection of information are
attributable to PBGC’s usage of experience-based burden estimation.
The information on plan experience is gathered by contacting nine
or fewer plan representatives. PBGC’s prior estimates of annual
hour burden and cost burden for the Request for Coverage
Determination form were not experienced-based, as this information
collection was new at the time.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.