LOCK-IN APPLICATION

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OMB Control Number 1212-0074 

Expires 07/31/2026

Updated 07/27/2023

MULTIEMPLOYER PROGRAM DIVISION 

LOCK-IN APPLICATION 

General Information

Under § 4262.10(g) of PBGC’s Special Financial Assistance (SFA) regulation, a filer may 

submit a lock-in application for an SFA-eligible multiemployer plan. The lock-in application is 

considered the plan’s initial application for SFA, and, as such, it locks in the plan’s base data 

upon the date of its filing to PBGC. Base data are the plan’s SFA measurement date, participant 

census data, non-SFA interest rate, and SFA interest rate (see § 4262.11(c)). Before March 11, 

2023, PBGC accepted a lock-in application only from a plan in priority group 5, priority group 6 

and only when the e-Filing Portal is temporarily closed. Beginning March 11, 2023, PBGC will 

treat a priority group plan the same as a nonpriority group plan and accept a lock-in application 

regardless of whether the e-Filing portal is open or temporarily closed. 

A lock-in application requires identifying information about the plan and plan sponsor, a 

statement of intent to lock in the plan’s base data from an authorized trustee or other authorized 

representative, and a certification signed by an authorized trustee. Upon receipt, PBGC will 

review the lock-in application only to ensure that it has been signed and provides the information 

required in § 4262.10(g) and these instructions. 

If the lock-in application satisfies the requirements of § 4262.10(g) and these instructions, then 

the application is considered filed and automatically denied for incompleteness (see 

§ 4262.10(g)(4)). PBGC will record the application’s filing date to establish the plan’s base data.

If the lock-in application does not meet the requirements of § 4262.10(g) and these instructions,

PBGC will not consider the lock-in application filed.

PBGC will hold the lock-in application until the earlier of the date a revised application is filed 

for the plan or December 31, 2026. The revised application must be completed in accordance 

with PBGC’s SFA regulation and the general instructions issued here and use the base data that 

was locked in as of the filing date of the lock-in application. 

Upon review of the plan’s revised application, if PBGC determines (based on the information 

available on the lock-in application filing date) that the plan was not eligible for SFA on the 

filing date of the lock-in application, then the lock-in application will not establish the plan’s 

base data (see §§ 4262.10(g)(1) and 4262.11(c)(2)). If the plan subsequently becomes eligible 

for SFA, the plan may file a revised application no later than December 31, 2026, to 

demonstrate eligibility and establish the plan’s base data in accordance with § 4262.11. 
LOCK-IN APPLICATION

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Filing a Lock-In Application

A lock-in application is subject to the filing rules in part 4000 of PBGC’s regulations. To submit 

a lock-in application, a filer must complete the form attached to these instructions, submit the 

form to multiemployerprogram@pbgc.gov, and include as the subject of the email “Lock-In

Application from (Plan Name)” or, if applicable, “Revised Lock-In Application from (Plan 

Name)” (see section below). You may send questions about this form to 

multiemployerprogram@pbgc.gov with the subject “Lock-in Application Question from (Plan 

Name).” 

After a Lock-In Application Is Received 

PBGC will send a confirmation email to the filer’s email address listed in the lock-in application. 

The email will state that PBGC received a lock-in application for the plan. If PBGC determines 

that the lock-in application does not meet the requirements of § 4262.10(g) and these 

instructions, then PBGC also will notify the filer. If the filer does not receive an email from 

PBGC within 10 business days of submission, contact PBGC at 

multiemployerprogram@pbgc.gov. 

Filing a Revised Lock-In Application

If a plan becomes aware before filing a revised application for PBGC review that it did not meet 

the eligibility requirements for SFA as of the lock-in application filing date, the plan may file a 

“revised lock-in” application when it subsequently becomes eligible. For example, the 

requirements for eligibility for a critical status plan under § 4262.3(a)(3) are satisfied by the 

information required to be filed for the specified year (see Section D, Item (3)c. of the general 

instructions). If a plan files a lock-in application as a critical status plan on June 1, 2023, and as 

of that date the plan has not filed a Form 5500 for the 2022 plan year (and the plan is unable to 

satisfy the active to inactive participant ratio requirement under § 4262.3(a)(3)(iii) for the 2020 

or 2021 plan years for which the Form 5500 has been filed), then the plan will have failed to 

establish eligibility for SFA as of the lock-in application filing date. Accordingly, the lock-in 

application will not establish the plan’s base data under § 4262.11(c) for purposes of calculating 

the amount of SFA. This is the case even if a Form 5500 for the 2022 plan year filed after the 

lock-in application filing date demonstrates that the ratio requirement under § 4262.3(a)(3)(iii) 

was met for the 2022 plan year. 

In that situation, a plan may file a revised lock-in application by submitting a new lock-in 

application with the check box in Part I filled in. PBGC will process a revised lock-in 

application in the same manner as it would an initial lock-in application. The plan’s base data 

will be established by the earliest lock-in application filed by the eligible plan that satisfies the 

requirements of § 4262.10(g) and these instructions. A revised lock-in application will not 

change the base data for a plan that previously filed a lock-in application if the plan was eligible 

for SFA as of the earlier filing date. 
LOCK-IN APPLICATION

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Part I. Plan Information 

 

___________________________________________________________________________________ 

Plan name 

 

___________________________________________ 

Role of filer 

 

___________________________________________ 

Street address of filer 

 

___________________________________________ 

City, State, ZIP Code of filer 

 

EIN PN 

 

___________________________________________ 

Plan sponsor name 

___________________________________________ 

Street address of plan sponsor 

 

___________________________________________ 

City, State, ZIP Code of plan sponsor 

 

___________________________________________ 

Plan sponsor’s authorized representative’s name (if any; 

if none, then leave these spaces blank) 

 

___________________________________________ 

Street address of authorized representative 

 

___________________________________________ 

City, State, ZIP Code of authorized representative 

Check this box if this filing is a revised lock-in 

application. (If not, leave the box unchecked.) 

 

 

_________________________________ 

Name of filer 

 

__________________________________ 

Email address of filer 

 

__________________________________ 

Telephone number of filer 

 

__________________________________ 

Email address of plan sponsor 

 

__________________________________ 

Telephone number of plan sponsor

 

__________________________________ 

Email address of authorized representative 

__________________________________ 

Telephone number of authorized 

representative 
LOCK-IN APPLICATION

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Part II. Eligibility 

The plan is eligible* for SFA because it meets the criteria for eligibility under (check all that 

apply): 

§ 4262.3(a)(1) of PBGC’s SFA regulation

§ 4262.3(a)(2) of PBGC’s SFA regulation

§ 4262.3(a)(3) of PBGC’s SFA regulation**

§ 4262.3(a)(4) of PBGC’s SFA regulation

* PBGC will not verify a plan’s assessment of its eligibility for SFA until it receives the plan’s

revised application. If PBGC determines that the plan was not eligible on the date when the

lock-in application was filed (based on information available at the time the plan filed its lock-in

application), then the lock-in application will not establish the plan’s base data.

**For information on how to determine eligibility under this provision, see Section D, Item (3)c 

of the general instructions. 

Part III. Certification 

This part must be signed and dated by an authorized trustee who is a current member of the 

board of trustees.

Under penalty of perjury under the laws of the United States of America, I declare that I am an 

authorized trustee who is a current member of the board of trustees of the: (insert plan name) 

_______________________________________________________________________ 

and that I have examined this application, and, to the best of my knowledge and belief, the 

application contains all the relevant facts relating to the application; all statements of fact 

contained in the application are true, correct, and not misleading because of omission of any 

material fact. 

______________________________________________________________________________ 

Signed Date 

____________________________________________ __________________________________ 

Printed name of signatory Title 
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LOCK-IN APPLICATION

Part IV. Statement of Intent

The part must be signed and dated by: (1) a trustee who is a current member of the board of 

trustees and authorized to sign on behalf of the board of trustees, or (2) another authorized 

representative of the plan sponsor. Part III and Part IV may but need not be signed by the same 

individual. 

By submitting this lock-in application, I am submitting an initial application for SFA for: (insert 

plan name) __________________________________________________________________________, 

with the intent to lock in the plan’s base data. 

______________________________________________________________________________ 

Signed Date

____________________________________________ __________________________________ 

Printed name of signatory Title

PAPERWORK REDUCTION ACT NOTICE

This section provides information on the time and cost estimates for preparing and filing the 

lock-in application. If you have any comments concerning the accuracy of these estimates or 

suggestions for making it simpler to submit the information, please send your comments to the 

Pension Benefit Guaranty Corporation, Office of the General Counsel, 445 12th Street, SW, 

Washington, DC 20024-2101. 

Information filed with PBGC in an application for special financial assistance (SFA) is

confidential only to the extent provided under the Privacy Act. PBGC may, in its sole discretion, 

post an application for SFA and any documents and information filed for the application on its 

website at www.pbgc.gov, or otherwise publicly disclose the application, documents, and 

information, except information that is confidential under the Privacy Act. 

PBGC will share with the U.S. Department of Labor and the Treasury Department (collectively,

the Agencies) a plan’s application, including any documents and information filed with PBGC, 

to enable the Agencies to fulfill their responsibilities under section 4262 of ERISA. 

This information collection is necessary for PBGC to properly administer the SFA program. 

PBGC uses the information it receives in a plan’s lock-in application to record the filing date for 

the plan’s initial application for SFA.

PBGC estimates an average per plan hour burden of 1 hour of fund office time and an average 

cost burden of $800 in contractor costs. These are estimates and the actual time and cost per 

plan will vary depending on the circumstances of a given filing and the size of the plan. 

This collection of information has been approved by the Office of Management and Budget 

(OMB) under control number 1212-0074 (expires 07/31/2026). 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.