Information Collection

Guarantee Agency Request For Reimbursement For Claims Paid Request For Reimbursement Under Agreement For Fed. Reinsurance - Request For Reimburse. On Death/disability

IC 134141 under ICR 198403-1840-006 · OMB 1840-0108.

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Information Collection (IC) Details

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IC Title:	GUARANTEE AGENCY REQUEST FOR REIMBURSEMENT FOR CLAIMS PAID REQUEST FOR REIMBURSEMENT UNDER AGREEMENT FOR FED. REINSURANCE - REQUEST FOR REIMBURSE. ON DEATH/DISABILITY	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.	Available Electronically?	Can Be Submitted Electronically?
Form	ED 1189	No	No
Form	1189-1,	No	No
Form	1189-3	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,800	0	1,800
Annual IC Time Burden (Hours)	3,190	40	3,150
Annual IC Cost Burden (Dollars)	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.