Form 200 Instructions

NOTICE OF FAILURE TO MAKE REQUIRED

CONTRIBUTIONS

The Form 200 is used to notify the Pension Benefit Guaranty Corporation of a failure to make required

contributions to a single-employer plan that is covered under ERISA section 4021 and whose FTAP is less than

100% if the total of unpaid balances, including interest, exceeds $1 million (see ERISA section 303(k)(4)

(A) and Code section 430(k)(4)(A)). For questions, contact (202) 326-4070 or form200@pbgc.gov. 

Table of Contents Page

Introduction 2 

General Instructions 4 

Definitions 6 

Specific Instructions 6 

General Plan Information 6 

Plan Funding Information 7 

Additional Information to be Filed 7 

Actuarial Information 8 

Certifications 9 

Appendix – Example of Calculation Concerning Failure to Make Required Funding Payments A-1
Form 200 Instructions

INTRODUCTION

ERISA §303(k) and Code §430(k) provide that a

lien arises in certain cases where there is a failure

to make required contributions to a singleemployer plan covered under ERISA §4021 whose

funding target attainment percentage (as defined in

ERISA §303(d) and Code §430(d)(2)) is less than

100 percent. The lien arises, in favor of the plan,

upon all property and rights to property (whether

real or personal) belonging to the person or persons

who are liable for required contributions (i.e., a

contributing sponsor and each member of the

controlled group of which that contributing sponsor

is a member)if:

1. any person fails to make a required

contribution payment when due, and

2. the unpaid balance of the payment (including

interest), when added to the aggregate unpaid

balance of all preceding such payments for

which payment was not made when due

(including interest), exceeds $1 million.

Any lien imposed for failure to make required

contributions may be perfected and enforced only

by PBGC or, at its direction, by the plan’s

contributing sponsor or any member of the

contributing sponsor’s controlled group. ERISA

§303(k)(4)(A) and Code §430(k)(4)(A) require that

PBGC be notified whenever there is a failure to

make a required payment and the total of unpaid

balances (including interest) exceeds $1 million.

Notice must be provided within 10 days of the due

date for the required payment.

To comply with this notification requirement,

PBGC regulations (29 CFR 4043.81) require that a

contributing sponsor and, if that contributing

sponsor is a member of a parent-subsidiary

controlled group, the “ultimate parent,” file Form

200 whenever such a failure occurs.

Note: PBGC’s decision not to require (at this time)

controlled group members other than

contributing sponsors and ultimate parents to file

Form 200 does not in any way limit the jointand-several liability of each controlled group

member for required payments (whether the

controlled group of which a contributing

sponsor is a member is a “parent-subsidiary,”

“brother-sister,” or “combined” group),

the imposition of the lien on all assets of

each controlled group member, or the ability

of PBGC to take all appropriate steps to

perfect and enforce the lien.

PBGC has restricted Form 200 to information

generally needed in its decision-making

regarding enforcement of a lien imposed by

ERISA §303(k) and Code §430(k). If PBGC

concludes that it needs additional information

in a particular case, it will notify (in writing) the

person required to supplement the Form 200

and specify the date by which the additional

information must be submitted.

What’s New

The Form 200 instructions and Form 200 have

been changed as follows:

• Added the amount of required payment

that resulted in the requirement to notify

PBGC (this is in addition to the already

required due date of required payment that

resulted in the requirement to notify

PBGC).

• PBGC no longer accepts electronic 

filing by email as of October 1, 2021.

PBGC’s e-filing portal, available for 

reportable events filings since 2016, 

offers a secure application for 

submitting Form 200 information. The

e-filing portal allows filers to:

− Review filings and generate a list

of omissions and inconsistencies

prior to submission to ensure that

filings are complete.

− Save a partially completed filing.

− Modify information any time prior to

submission.

− Pre-populate a filing with data from a

previously submitted filing.

− Route the filing as needed to facilitate ecertifications.

− Review prior filings submitted via the efiling portal.

2
Form 200 Instructions

3

The portal can be accessed using the following

address: efilingportal.pbgc.gov.

Notification of future changes to any forms and

instructions may be found under “What’s

New” on the Employers & Practitioners page

at www.pbgc.gov/whatsnew.
4

Form 200 Instructions

GENERAL INSTRUCTIONS

Who Must File

Form 200 must be filed by (1) a contributing

sponsor and (2) if a contributing sponsor is a

member of a “parent-subsidiary” controlled

group, the ultimate parent of such group. 

However, if a timely and complete Form 200 is

properly filed by either a contributing sponsor or 

the ultimate parent, PBGC will deem the other to

have so filed. (As noted in the “Introduction,”

each other member of any controlled group of

which a contributing sponsor is a member also is

jointly and severally liable for required 

payments, and PBGC may enforce the statutory

lien imposed on its assets.) 

Note: An authorized representative may file a 

Form 200 on behalf of a contributing sponsor, a 

parent, or both. 

Special Rule for Terminating Plans: The fact that

a plan is in the process of terminating does not

mean that a Form 200 notice need not be filed. 

However, a notice is waived if the deadline for

filing the notice is on or after the date on which 

(1) all of the plan’s assets (other than any

excess assets) are distributed pursuant to a

termination or (2) a trustee is appointed for

the plan under ERISA § 4042(c).

How to File 

Forms must be prepared and filed 

electronically using the 4043 module of 

PBGC’s e-filing portal. To request an 

exemption from e-filing, send a request via 

email to form200@pbgc.gov. 

Attaching files

Filers may attach electronic files to their submission.

Examples of files that may be attached include, but

are not limited to, actuarial valuation reports,

financial statements, and organizational charts. 

If you are filing materials electronically that are 

larger than 10 megabytes, please use Leap-FILE. 

First send an email to form200@pbgc.gov to request 

a recipient email address. The email address provided 

will be that of a PBGC staff member, e.g., a “[last 

name].[first name]@pbgc.gov” email address. Enter 

“pbgc.leapfile.com” in your Internet browser, click 

on “secure upload,” enter the email address provided 

by PBGC in the “Recipient Email” field, and attach 

the files. 

When to File 

Form 200, including all required documentation and 

information, must be filed with PBGC no later than 

10 days after the due date for the required payment. 

Note: Form 200 must be filed each time there is a 

failure described in ERISA § 303(k)(1) and Code 

§ 430(k)(1) and the total of unpaid balances of

required payments (including interest) exceeds $1

million.

Notice Filing Date 

The date a Form 200 is considered to have been filed 

is the date received through PBGC’s e-filing portal. 

See 29 CFR § 4000.29. 

Computation of time: In computing the 10-day 

period, the due date of the payment that resulted in 

the requirement to notify PBGC is not included. 

Form 200 is due 10 days thereafter unless that 

day is a Saturday, Sunday, or Federal holiday, in 

which case the 10-day period runs until the next day 

that is not a Saturday, Sunday, or Federal holiday. 

Information received on a weekend or Federal holiday 

or after 5:00 p.m. on a weekday is considered filed 

on the next regular business day.
Form 200 Instructions

5

What to File

A contributing sponsor must use the PBGC Form 200 

to file a notice of a failure to make required

contributions. Certain individual items on the form

call for additional information.

Attachments 

If responding to an item requires the attachment of

documentation or information, mark the attachment

to identify the item to which it responds. 

Previously Submitted Information 

Because ERISA §303(k)(4)(A) and Code 

§430(k)(4)(A) require that PBGC be notified each

time there is a failure to make a required payment and

the total of unpaid balances of required payments

(including interest) exceeds $1 million, more than

one filing may be required regarding the same plan,

and at least some of the information included in a

previous Form 200 filing may continue to be accurate

and responsive at the time that a subsequent Form

200 must be filed. It also is possible that information

submitted to PBGC in another context (e.g., in a

distress termination filing pursuant to ERISA

§4041(c) or in a notice of a reportable event required

by 29 CFR Part 4043) is responsive. A filer may

respond to an item that calls for previously submitted

documentation or other information by identifying

the previous submission in which the response was

provided.

Effect of Failure to Timely File

If a Form 200 (or other required information) is not

provided within the specified time limit, PBGC may

assess a penalty under ERISA §4071 against each

person required to provide the Form 200 (see 29 CFR

Part 4071 and PBGC’s Statement of Policy on 

Assessment of Penalties for Failure to Provide 

Required Information (60 FR 36837, July 18, 1995)). 

PBGC may pursue any other equitable or legal

remedies available to it under the law.

For Questions or Problems Regarding Form

200

If you have questions or problems regarding Form

200 or these instructions, contact: 

Pension Benefit Guaranty Corporation 

Corporate Finance and Restructuring Department 

445 12th Street SW, Washington DC 20024-2101

Telephone: 202-326-4070

Email: form200@pbgc.gov 

If you are having problems using the e-filing portal, 

contact PBGC at efiling.portal@pbgc.gov. 

If you are deaf, hard of hearing, or have a speech 

disability, please dial 7-1-1 to access 

telecommunications relay services. 

Copies of Form 200 and instructions may be 

obtained from PBGC’s website at http://

www.pbgc.gov/prac/ forms.

Reportable Event 

A failure to make a required contribution may also 

be a reportable event under 29 CFR 4043.25(a). If 

with respect to such failure, a Form 200 is 

completed and submitted in accordance with 29 

CFR 4043.81, the Form 200 filing is deemed 

to satisfy the reportable event requirement 

(see 29 CFR 4043.25(b)). 

Note: If a contributing sponsor or controlled group 

member files a complete Form 200 with PBGC 

within 10 days of the due date of the payment in 

accordance with 29 CFR §4043.81, the Form 200 

filing satisfies the notice requirement for purposes of 

29 CFR 4043.25(a). However, Form 10 may also be 

filed if desired. Choosing to rely on Form 200 to 

satisfy the Form 10 filing requirement does not make 

the Form 200 a reportable event filing under ERISA 

§4043 and does not give the Form 200 filing the

benefit of the confidentiality protection for

reportable event notices under ERISA §4043(f).
Form 200 Instructions

6

DEFINITIONS

As used in PBGC Form 200 and these instructions:

Code means the Internal Revenue Code of 1986, as

amended.

Contributing sponsor means a person that is a

contributing sponsor as defined in ERISA §4001(a)

(13).

Controlled group, for purposes of ERISA §303(k)

and Code §430(k), means any group treated as a

single employer under subsection (b), (c), (m), or

(o) of Code §414.

Due date means the date set forth in ERISA §303(j)

and Code §430(j) for payment of a required

installment and, in the case of a payment other than a

required installment, the date such payment is

required to be made under ERISA §303 and Code

§430.

EIN/PN means the nine-digit employer

identification number assigned by the Internal

Revenue Service to a person and the three-digit plan

number assigned to a plan. The EIN/PN should be

the EIN/PN most recently reported for a PBGC

premium filing (if applicable).

ERISA means the Employee Retirement Income

Security Act of 1974, as amended.

IRS means the Internal Revenue Service.

Notice due date meansthe deadline for filing a Form

200 with PBGC.

Notice Filing Date means the date the Form 200

is received by PBGC.

Person means an individual, partnership, joint

venture, corporation, mutual company, joint-stock

company, trust, estate, unincorporated organization,

association, or employee organization.

Required installment means any of the four

quarterly contribution payments required for each

plan year by ERISA §303(j) and Code §430(j).

Required payment means a required installment or

other payment required under ERISA §§ 302 and 303

and Code §§ 412 and 430 or as a result of a funding

waiver.

Single-employer plan means any defined benefit

plan (as defined in ERISA §3(35)) that is not a

multiemployer plan (as defined in ERISA

§4001(a) (3)) and that is covered by title IV of

ERISA.

Ultimate Parent means the parent at the highest

level in the chain of corporation and/or other

organizations constituting a parent-subsidiary

controlled group. (For example, if Corporation A

owns all of the stock of Corporation B and

Corporation C, and Corporation B owns all of the

stock of Corporation X, the contributing sponsor,

then the “ultimate parent” of Corporation X is

Corporation A.)

SPECIFIC INSTRUCTIONS

General Plan Information

• Complete name of the plan as it appears on the

plan document and the plan year commencement

date

• The EIN/PN reported should be the EIN/PN most

recently reported for a PBGC premium filing (if

applicable). If the plan has never made a PBGC

premium filing, enter the EIN assigned to the

contributing sponsor by the IRS for income tax

purposes and the PN assigned by the contributing

sponsor.

• Name, address, telephone number, and email

address of the individual or the board or other

entity, if any, specifically designated as plan

administrator by the terms of the plan or trust

agreement. If none is so designated, enter the

name, address, telephone number, and email

address of the contributing sponsor.
Form 200 Instructions

7

• The name, title, e-mail address, and phone

number of an individual whom PBGC should

contact if it has questions about the filing.

Plan Funding Information

Note: An enrolled actuary must certify that the

information in this section is true, correct, and

complete, and conforms to applicable regulatory

requirements (see Certification section).

• Due date of required payment.

• Amount of the required payment.

• The total amount, as of the due date, of the

unpaid balance of the required payment and the

aggregate unpaid balance of all preceding

required payments for which payment was not

made when due (i.e., include in this amount the

unpaid balances, including interest, of all

required payments for which payment was not

made when due). See Appendix for an example

of how to compute the total amount.

• Description of how the unpaid balance of

required payments was determined. This

description must include an attached spreadsheet

that shows the details of the calculation (see

Appendix for an example of how the required

information may be shown).

Additional Information to be Filed

Additional information to be filed (check all boxes

for information attached to form; see below for

description of Actuarial Information required).

• Description of the plan’s controlled group

structure (including the contributing sponsor and

the ultimate parent of the controlled group),

including the name, address, telephone number,

and EIN of each controlled group member

• Location of real property owned by each

controlled group member

• Name and address of the controlled group’s

principal executive office

• Operational status of each controlled group

member (in Chapter 7 proceedings, liquidating

outside of bankruptcy, in Chapter 11

proceedings, on-going, etc.)

• Name, address, telephone number and EIN of

• each contributing sponsor of the plan

• Reason contribution was not made by due date

• Copy of any IRS letter(s) granting or modifying

a funding waiver and/or extension of the

amortization period

• Statement describing any pending request(s) for

a funding waiver and/or extension of the

amortization period

• Copies of audited financial statements (if

available) or (if not) unaudited financial

statements that were prepared for the

contributing sponsor and each other controlled

group member individually, including balance

sheets, income statements, statements of cash

flows,

• and notes to financial statements and annual

reports. However, if financial statements were

only prepared on a consolidated basis for more

than one controlled group member, consolidated

financial statements and consolidating financial

statements (if available) and (if not)

consolidating trial balances that identify each

controlled group member individually may be

attached instead. Copies of financial statements

for the most recent three fiscal years available,

and the most recent available interim financial

statement, for each member of the plan’s

controlled group, including the contributing

sponsor and the ultimate parent

Also include an explanation of any information

required to be filed but missing from the filing.

Note – Simplified Reporting: Most “Additional

Information to be Filed” does not need to be

submitted if the filer has not missed any required

contribution (other than the missed contribution that

triggered the Form 200 filing requirement) during
Form 200 Instructions

8

the two-year period ending on the notice due date for

the Form 200 and has made up the missed

contribution by the notice due date. The only

additional information required is the reason the

contribution was not made by the due date. PBGC

may also request evidence that the contribution has

been made. The filer should note Simplified

Reporting is being used in the missing information

section of the filing.

Actuarial Information

Please include the following for each plan

maintained by any member of the plan’s controlled

group:

• Copy of the most recent Actuarial Valuation

Report that includes or is supplemented with all

of the items described below. If the amount of the

most recent missed contribution is based on a

calculation that is not reflected in the most recent

Actuarial Valuation Report, also provide all of

the information described below that supports the

calculation:

– The funding target calculated pursuant to

ERISA section 303 without regard to

subsection 303(i)(1), setting forth separately

the value of the liabilities attributable to

retirees and beneficiaries receiving payment,

terminated vested participants, and active

participants (showing vested and non-vested

benefits separately;

– A summary of the actuarial assumptions and

methods used for purposes of ERISA section

303 and any changes in those assumptions

and methods since the previous valuation and

justifications for any change; in the case of a

plan that provides lump sums, other than de

minimis lump sums, the summary must

include the assumptions on which

participants are assumed to elect a lump sum

and how lump sums are valued;

– The effective interest rate (as defined in ERISA section 303(h)(2)(A) and Code section

430(h)(2)(A));

– The target normal cost calculated pursuant to

ERISA section 303 without regard to

subsection 303(i)(2) (and Code section 430

without regard to subsection 430(i)(2));

– For the plan year and the four preceding

plan years, a statement as to whether the

plan was in at-risk statusfor that plan year;

– In the case of a plan that is in at-risk status,

the target normal cost calculated pursuant

to ERISA section 303 as if the plan has

been in at-risk status for 5 consecutive

years;

– The value of the plan’s assets (reflecting any

averaging method) as of the valuation date

and the fair market value of the plan’s

assets as of the valuation date;

– The funding standard carryover balance and

the prefunding balance (maintained

pursuant to ERISA section 303(f)(1) and

Code section 430(f)(1)) as of the

beginning of the plan year and a summary of

any changes in such balances in the past

year (e.g., amounts used to off- set

minimum funding requirement, amounts

reduced in accordance with any elections under ERISA section 303(f)(5) or Code section

430(f)(5), interest credited to such balances,

and excess contributions used to increase

such balances);

– A list of amortization bases (shortfall and

waiver) under ERISA section 303 and

Code section 430, including the year

the base was established, the original

amount, the installment amount, and

the remaining balance at the beginning of

the plan year;

– An age/service scatter for active

participants including average

compensation information for payrelated plans and average account
Form 200 Instructions

9

balance information for hybrid plans

presented in a format similar to that

described in the instructionsto Schedule SB of

the Form 5500;

– Expected disbursements (benefit

payments and expenses) during the planyear;

and

– A summary of the principal eligibility and

benefit provisions on which the valuation

of the plan was based (and any changes to

those provisions since the previous

valuation), along with descriptions

of any benefits not included in the

valuation, any significant events that

occurred during the plan year, and the

plan’s early retirement factors; in the case of a

plan that provides lump sums, other than de

minimis lump sums, the summary must

include information on how annuity

benefits are converted to lump sum

amounts (for example, whether early

retirement subsidies are reflected).

• Statement of any material change in liabilities

of the plan occurring after the date of the

most recent Actuarial Valuation Report.

• Most recent month-end market value of

plan assets.

• Contact name, telephone number, and

employer of the plan actuary if differentfrom

that listed on the most recently filed

Schedule SB to Form 5500.

• Copies of election letters relating to

the application of carryover or prefunding

balances to the contributions.

Certifications

Plan funding information and related explanation

certification must be made by an enrolled actuary

Contributing Sponsor or Parent

Certification must be made by an officer (or an

individual of comparable authority in an

unincorporated organization) of the contributing

sponsor or ultimate parent that is filing the Form

200.
Form 200 Instructions

A-1

APPENDIX

Example on How to Describe the Aggregate Unpaid Balance of Required Funding Payments

Assume the plan sponsor of a calendar-year plan:

• missed a required 2017 quarterly installment of $600,000 on January 15, 2018

• made a contribution of $200,000 on March 1, 2018

• missed a 2018 required quarterly installment of $500,000 on April 15, 2018

• missed a 2018 required quarterly installment of $500,000 on July 15, 2018

• missed the final 2017 required contribution of $150,000 on September 15, 2018

In addition, assume the effective interest rate for plan year 2017 was 8% and for plan year 2018 was 6%. Adding

5% (see ERISA §303(j)(3)(A)) to the effective interest rates for the periods of underpayment, the applicable interest

rates for the missed quarterlies for the 2017 and 2018 plan years are 13% and 11%,respectively.

Aggregate Unpaid Balance of Required Contributions as of 7/15/2018

Date Contribution

Type

Applicable Plan

Year

Applicable Interest

Rate Amount Days until07/15/2018

Interest

Adjustment Total

01/15/2018/Quarterly Missed 2017 13% $600,000 181 $37,488 $637,488

03/01/2018/Quarterly Paid 2017 13% -$200,000 136 -$9,318 -$209,318

04/15/2018/Quarterly Missed 2018 11% $500,000 91 $13,180 $513,180

07/15/2018/Quarterly Missed 2018 11% $500,000 0 $0 $500,000

Total $1,400,000 $41,350 $1,441,350

Because the aggregate unpaid balance of required payments as of July 15, 2018 ($1,441,350) exceeds $1,000,000, a

Form 200 filing is due on July 25, 2018 (10 days after the missed contribution, with weekend extension). The table

shown above is an example of the data to be submitted with the Form 200 filing.

Aggregate Unpaid Balance of Required Contributions as of 9/15/2018

Date Contribution

Type

Applicable Plan

Year

Applicable Interest

Rate Amount Days until07/15/2018

Interest

Adjustment Total

01/15/2018/Quarterly Missed 2017 13% $600,000 243 $50,861 $650,861

03/01/2018/Quarterly Paid 2017 13% -$200,000 198 -$13,709 -$213,709

04/15/2018/Quarterly Missed 2018 11% $500,000 153 $22,358 $522,358

07/15/2018/Quarterly Missed 2018 11% $500,000 62 $8,942 $508,942

09/15/2018/Final Missed 2017 8% $150,000 0 $0 $150,000

Total $1,550,000 $68,452 $1,618,452

Because the aggregate unpaid balance of required payments as of September 15, 2018 ($1,618,452) exceeds

$1,000,000, an updated Form 200 filing is due on September 25, 2018 (10 days after the missed contribution, with

weekend extension). The table shown above is an example of the data to be submitted with the Form 200 filing.
Form 200 Instructions

PAPERWORK REDUCTION ACT NOTICE

PBGC needs this information, which is required to be filed under section 303(k)(4) of ERISA and section

430(k)(4) of the Internal Revenue Code (the Code) and 29 CFR Part 4043, Subparts A and D, to make decisions

regarding enforcement of a lien imposed by section 303(k)(1) of ERISA and section 430(k)(1) of the Code.

Information provided to PBGC is confidential to the extent provided in the Freedom of Information Act and

the Privacy Act. 

PBGC estimates that it will take an average of 1 hour and $725 to comply with the requirements described in 

these instructions. These figures are estimated averages that will vary depending on the nature and 

organizational structure of persons liable for plan contributions (in particular, whether the plan’s contributing 

sponsor is a member of a controlled group and, if so, the size of that group) and on the funding history of the 

plan. 

If you have any comments concerning the accuracy of these time estimates or suggestions for improving the 

form or these instructions, please send your comments to the Pension Benefit Guaranty Corporation, Regulatory Affairs Group, Office of the General Counsel, 445 12th Street SW, Washington, DC 20024-2101. 

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

control number 1212-0041. 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.