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(PGC logo)Request for Coverage Determination OMB No: 121200XX Expires: XX/This form is used by a plan administrator or plan sponsor of a plan to request that the Pension Benefit Guaranty Corporation
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OMB No 1212-00xx is a unique control number assigned by the Office of Management and Budget (OMB) to a specific information collection form.
The specific entity or individual required to file OMB No 1212-00xx will depend on the nature of the information being collected.
To fill out OMB No 1212-00xx, follow the instructions provided on the form and provide the requested information accurately and completely.
The purpose of OMB No 1212-00xx is to collect specific information for a particular regulatory or administrative process.
The information required to be reported on OMB No 1212-00xx will be specified on the form itself.
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