Administrative Appeals

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0061 can be found here:

Documents and Forms

Document Name Document Type
Form 724 Administrative Appeals Form and Instruction
724 Appeal of a PBGC Benefit Determination PBGC Form 724, 2022 submission.pdf Form and Instruction
724 Appeal of a PBGC Benefit Determination PBGC Form 724, 2022 submission.pdf Form and Instruction
723 Request for Additional Time to File an Appeal of a PBGC PBGC Form 723, 2022 submission.pdf Form and Instruction
723 Request for Additional Time to File an Appeal of a PBGC PBGC Form 723, 2022 submission.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Administrative Appeals	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 4003 Subpart D

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	724	Appeal of a PBGC Benefit Determination	PBGC Form 724, 2022 submission.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	723	Request for Additional Time to File an Appeal of a PBGC Benefit Determination	PBGC Form 723, 2022 submission.pdf		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: PBGC - 10: Administrative Appeals Files	FR Citation: 83 FR 6247

Number of Respondents: 375	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	375	-222	597
Annual IC Time Burden (Hours)	293	82	211
Annual IC Cost Burden (Dollars)	37,400	4,127	33,273

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.