Benefit Determination Appeal Forms
For your convenience, PBGC has optional forms you may use to request an extension of time to file an appeal or to file an appeal. Use of Form 723 (Request for Additional Time to File an Appeal of a PBGC Benefit Determination) and Form 724 (Appeal of a PBGC Benefit Determination) is not required in order to request an extension of time or file an appeal. You can request an extension of time or file an appeal by letter or by email as long as your letter or email contains all of the information requested on the respective forms.
Using The Forms
If you wish to use either optional Form 723 or optional Form 724, you will need to first print the form on your local printer and then complete it manually. When filling in the form use dark ink and be sure to print clearly. You must sign the form before you submit it to PBGC. PBGC publications and forms are available in Adobe Acrobat's portable document format (PDF). The PDF files must be viewed with the Adobe Reader® software. If you do not have the Adobe Reader® installed on your computer, you can download the appropriate version for your computer from the Adobe website (Windows, Macintosh, and Unix versions are available). After you install the software on your computer, return to the PBGC website and open the PDF file. If you still have problems viewing or downloading a PDF file, email firstname.lastname@example.org for assistance.
Submitting Your Request or Appeal
You may either mail your letter or completed form, any additional pages, copies of supporting documents (if any), and a power of attorney (if required - see item 5 of the optional forms or the explanation of when a power of attorney is required in the Your Right To Appeal brochure in the section titled You Do Not Need an Attorney to Represent You), to:
Pension Benefit Guaranty Corporation
Attention: Appeals Division
Post Office Box 151750
Alexandria, VA 22315-1750
or, you may fax your letter or completed form to the Appeals Division at (202) 326-4095 or (202) 326-4091. If you wish to email your request or appeal, send it to email@example.com.
Paperwork Reduction Act Notice Paperwork
The PBGC needs this information, which is required to be filed under 29 CFR Part 4003, so that it can handle appeals of PBGC initial determinations in certain circumstances. PBGC estimates that it will take an average of 0.75 hours and $55 to comply with these requirements. If you have any comments concerning the accuracy of this estimate or suggestions for improving this form, please send your comments to the Pension Benefit Guaranty Corporation, Legislative and Regulatory Department, 1200 K Street, N.W., Washington, D.C. 20005-4026. This collection of information has been approved by the Office of Management and Budget (OMB) under control number 1212-0061 (expires 5/31/16). 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.