Retirement Savings Lost and Found

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Data Elements
Retirement Savings Lost and Found Voluntary
Information Collection Request
The requested data elements set out in sections III, IV and V of the Proposed Information
Collection Request (89 FR 26932 (April 16, 2024)) are duplicated below and redlined to show
the changes made in response to public comments. The remaining data elements constitute the
revised information collection request.
III. Plans With Separated Vested Participants
For any plan with a participant or former participant described in 26 U.S.C. 6057(a)(2)(C)(i) and
(ii) (“separated vested participant”), provide the following information with respect to the plan in
accordance with filing instructions created by the Department:
1. Name and plan number of plan as reflected on the most recent Form 5500 Annual
Return/Report of Employee Benefit Plan or Form 5500-SF Short Form Annual Return/Report of
Employee Benefit Plan (individually and collectively “Form 5500”).
2. Name, employer identification number (EIN), mailing address, and telephone number of the
plan administrator as reflected on the most recent Form 5500.
3. Name, EIN, mailing address, and telephone number of the plan sponsor as reflected on the
most recent Form 5500. If the plan had plan sponsors other than the plan sponsor on the most
recent Form 5500, provide the names and EINs of the prior plan sponsors and include the date of
change.
4. Name, date of birth, mailing address, email address, telephone number, and social security
number (SSN) of each separated vested participant.
5. Nature, form, and amount of benefit of each separated vested participant.
6. If the vested benefit of each such separated vested participant was fully paid in a form other
than an annuity ( i.e., lump sum payout) to the separated vested participant, provide the date and
the amount of the distribution.
7. If an annuity form of benefit, state whether the separated vested participant has begun
receiving benefits, the date of the annuity commencement, and the monthly benefit.
4. Name, date of birth, mailing address, email address, telephone number, and SSN of any
separated vested participant aged 65 (or older) who is owed a vested benefit., and who has been

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unresponsive to plan communications about their benefits or whose contact information as set
forth in paragraph 4 above, the plan has reason to believe is no longer accurate.
9. Name, date of birth, mailing address, email address, telephone number, and SSN of any
designated beneficiary of the separated vested participant.
10. With respect to any participant whose benefit was transferred to the plan in the manner
described in Line 9 of the Form 8955-SSA, provide the name and plan number of the transferor
plan. Include the date of transfer to the plan.
IV. Plans That Distributed Benefits Under Section 401(a)(31)(B) of the Internal Revenue
Code –
For any plan that distributed benefits under section 401(a)(31)(B) of the Code, provide the
following information with respect to the plan:
1. Name of plan and plan number as reflected on the most recent Form 5500. If the plan had
names other than the name on the most recent Form 5500, provide the prior names and plan
numbers to include the date of change.
2. Name, EIN, mailing address, and telephone number of the plan administrator as reflected on
the most recent Form 5500. If the plan had plan administrators other than the plan administrator
on the most recent Form 5500, provide the names and EINs of the prior plan administrators and
include the date of change.
3. Name, EIN, mailing address, and telephone number of the plan sponsor as reflected on the
most recent Form 5500, if different than the plan administrator. If the plan had plan sponsors
other than the plan sponsor on the most recent Form 5500, provide the names and EINs of the
prior plan sponsors and include the date of change.
4. Name, date of birth, mailing address, email address, telephone number and SSN of each
participant or former participant with respect to whom any amount of the vested benefit was
distributed under section 401(a)(31)(B) of the Code.
5. With respect to such participant or former participant, the name of the designated trustee or
issuer described in section 401(a)(31)(B) of the Code.
6. With respect to such participant or former participant, the address of the designated trustee or
issuer described in section 401(a)(31)(B) of the Code.
7. With respect to such participant or former participant, the amount of the distribution.
8. With respect to such participant or former participant, the account number of the individual
retirement plan to which the amount was distributed.

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9. With respect to such participant or former participant, the name, date of birth, mailing address,
email address, telephone number, and SSN of any designated beneficiary.
V. Plans That Distributed Annuities
For any plan that distributed benefits pursuant to an annuity contract described in 29 CFR
2510.3-3(d)(2)(ii), provide the following information with respect to the plan:
1. Name and plan number of plan as reflected on the most recent Form 5500. If the plan had
names other than the name on the most recent Form 5500, provide the prior names and plan
numbers to include the date of change.
2. Name, EIN, mailing address, and telephone number of the current plan administrator as
reflected on the most recent Form 5500. If the plan had plan administrators other than the plan
administrator on the most recent Form 5500, provide the names and EINs of the prior plan
administrators and include the date of change.
3. Name, EIN, mailing address, and telephone number of plan sponsor as reflected on the most
recent Form 5500, if different than the plan administrator. If the plan had plan sponsors other
than the plan sponsor on the most recent Form 5500, provide the names and EINs of the prior
plan sponsors and include the date of change.
4. Name, date of birth, SSN, mailing address, email address, and telephone number of each
participant or former participant with respect to whom an annuity contract, described in 29 CFR
2510.3-3(d)(2)(ii), was distributed.
5. With respect to such participant or former participant, the name of the issuer of the annuity
contract.
6. With respect to such participant or former participant, the address of the issuer of the annuity
contract.
7. With respect to such participant or former participant, the contract or certificate number.
8. With respect to such participant or former participant, the name, date of birth, mailing,
address, email address, telephone number, and SSN of any designated beneficiary.