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Application For Insurance Benefits And General Assignment
APPLICATION FOR INSURANCE BENEFITS AND GENERAL ASSIGNMENT
OMB: 2502-0050
IC ID: 143561
OMB.report
HUD/OH
OMB 2502-0050
ICR 197904-2502-008
IC 143561
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2502-0050 can be found here:
1982-08-31 - Extension without change of a currently approved collection
1981-03-13 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
APPLICATION FOR INSURANCE BENEFITS AND GENERAL ASSIGNMENT
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
2777B
No
No
Form
HUD 2777,
No
No
Form
2777A, &
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
5,000
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
5,000
0
0
0
0
5,000
Annual IC Time Burden (Hours)
2,500
0
0
0
0
2,500
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.