Pbgc Form 707 - Designation Of Beneficiary (Currently Receiving Pension Benefits) printable pdf download

Designation of Beneficiary

PBGC Form 707

Approved OMB 1212-0055

(Currently Receiving Pension Benefits)

Expires 09/30/08

Pension Benefit Guaranty Corporation.

For assistance, call 1-800-400-7242

P.O. Box 151750 • Alexandria, VA 22315-1750

PRIVACY ACT NOTICE

The Privacy Act of 1974, as amended, 5 U.S.C. § 552a (1994), requires PBGC to give you this notice when collecting

information from you. PBGC uses the information to determine whether and how much of a pension benefit is due you under a

private defined benefit pension plan that has terminated, and to make appropriate benefit payments. Your Social Security

Number is used by PBGC to identify your records within PBGC, to report income for tax purposes, and to respond to lawful

requests for information about you from other individuals and entities. Your response is voluntary. However, failure to provide

information to PBGC, including your Social Security Number, may delay or prevent PBGC from calculating and paying your

pension benefits.

PBGC may release information about you to other individuals and entities when necessary and appropriate under the

Privacy Act, including: to third parties to make benefit payments to you; to a company that was responsible for your pension

plan or to entities related to that company; to a labor organization that represents you; to obtain information from the Federal

Aviation Administration relevant to a pilot or former pilot’s eligibility for a disability benefit; to obtain your address from other

sources when PBGC does not have a current or valid address for you; and to a limited extent to your spouse, former spouse,

child, or other dependent when such individual may be entitled to benefits from PBGC.

PBGC may also release information about you to appropriate law enforcement agencies when PBGC becomes aware of a

possible violation of civil or criminal law. If PBGC, an employee of PBGC, the United States, or another agency of the United

States, is involved in litigation, PBGC may provide relevant information about you to a court or other adjudicative body or to the

Department of Justice when it represents PBGC. PBGC may also provide information about you to the Office of Management

and Budget in connection with review of private relief legislation or to a Congressional office in response to an inquiry that

office makes about you at your request.

PBGC publishes notices in the Federal Register that describe in more detail when information about you may be made

available to others. A copy of the most recent Federal Register notice may be obtained from PBGC’s Contact Center

by calling 1-800-400-7242. For TTY/TDD users, call the federal relay service toll free at 1-800-877-8339 and ask to be

connected to 1-800-400-7242. PBGC’s authority to collect information from you, including your Social Security Number, is

derived from 29 U.S.C. §§ 1055, 1056(d)(3), 1302, 1321, 1322, 1322a, 1341 and 1350 (1994).

PAPERWORK REDUCTION ACT NOTICE

The PBGC needs this information so that it can determine your entitlement, if any, to a pension benefit under a private

defined benefit pension plan that has terminated. A defined benefit plan is a traditional pension plan that promises a specified

monthly benefit at retirement. The PBGC does not pay benefits under 401(k) or other defined contribution plans, ongoing

defined benefit plans, government plans, and certain other plans. Your response is voluntary. However, the information is

required in order for you to receive such a pension benefit. The PBGC will use this information to determine the form and

amount of any such pension benefit and to make appropriate payments. Under the Paperwork Reduction Act, an agency may

not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid

OMB control number. This collection of information has been approved by the Office of Management and Budget (OMB) under

control number 1212-0055 (expires 08/31/08). The information provided to the PBGC may be disclosable under the Freedom

of Information Act and the Privacy Act. The PBGC estimates that the average burden of responding to a request for identifying

information as part of an initial contact with the PBGC under the PBGC’s Pension Search program is about 16 minutes, and

that the average burden of complying with the information collection request in the PBGC's application package is about 34

minutes. Comments concerning the accuracy of this estimate or suggesti ons for further reducing this burden may be sent to

Pension Benefit Guaranty Corporation, Office of the General Counsel, 1200 K Street, NW, Washington, DC 20005-4026.

Pbgc Form 707 - Designation Of Beneficiary (Currently Receiving Pension Benefits)

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