Annual Statement of Compliance

Special Financial Assistance by PBGC

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0074 can be found here:

Documents and Forms

Document Name Document Type
Form SFA 300 Annual Statement of Compliance Form and Instruction
SFA 300 Annual Statement of Compliance Annual Statement of Compliance (Final Rule), OMB Submission.docx www.pbgc.gov/sites/default/files/sfa/annual-statement-compliance-v2.pdf Form and Instruction
SFA 300 Annual Statement of Compliance Annual Statement of Compliance (Final Rule), OMB Submission.docx www.pbgc.gov/sites/default/files/sfa/annual-statement-compliance-v2.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Annual Statement of Compliance	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4262

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SFA 300	Annual Statement of Compliance	Annual Statement of Compliance (Final Rule), OMB Submission.docx	https://www.pbgc.gov/sites/default/files/sfa/annual-statement-compliance-v2.pdf	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: PBGC – 19: Office of General Counsel Case Management System	FR Citation: 83 FR 6247

Number of Respondents: 106	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	106	57	49
Annual IC Time Burden (Hours)	212	114	98
Annual IC Cost Burden (Dollars)	254,400	136,800	117,600

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.