Lock-In Application

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⚠️ Notice: This information collection may be referencing outdated material.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 Lock-in Applicatio Lock-In Application Form and Instruction
Lock-in Applicatio Lock-in Application lock-in-application.pdf www.pbgc.gov/sites/default/files/sfa/lock-in-application.pdf Form and Instruction
Lock-in Applicatio Lock-in Application lock-in-application.pdf www.pbgc.gov/sites/default/files/sfa/lock-in-application.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Lock-In Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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	Lock-in Application	Lock-in Application	lock-in-application.pdf	https://www.pbgc.gov/sites/default/files/sfa/lock-in-application.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: 6	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	6	-17	23
Annual IC Time Burden (Hours)	6	-17	23
Annual IC Cost Burden (Dollars)	4,800	-13,600	18,400

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.