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

GUARANTEE AGENCY REQUEST FOR REIMBURSEMENT FOR CLAIMS PAID REQUEST FOR REIMBURSEMENT UNDER AGREEMENT FOR FED. REINSURANCE - REQUEST FOR REIMBURSE. ON DEATH/DISABILITY

OMB: 1840-0108

IC ID: 171197

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GUARANTEE AGENCY REQUEST FOR REIMBURSEMENT FOR CLAIMS PAID REQUEST FOR REIMBURSEMENT UNDER AGREEMENT FOR FED. REINSURANCE - REQUEST FOR REIMBURSE. ON DEATH/DISABILITY
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1189, 1189-1 No No
Form 1189-2 No No
Form 1189-3 No No


    

50 0
   
State, Local, and Tribal Governments
 
   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 1,800 0 0 0 0 1,800
Annual IC Time Burden (Hours) 3,190 0 0 0 0 3,190
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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