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Federal forms, ICRs, and supporting documents

Information Collection

Notice of Issuance of Insurance Policy

IC 13700 under ICR 200610-1215-001 · OMB 1215-0059.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Notice of Issuance of Insurance Policy
 
No Modified
 
Mandatory
 
20 CFR 726.208 -.213 20 CFR 726.206

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CM-921 Instructions for Completion of Form CM-921 CM-921 form and Instructions draft 9-20-06.pdf http://www.dol.gov/esa/regs/compliance/owcp/cm-921.pdf Yes No Fillable Printable
Form and Instruction CM-921 Instructions for Completion of Form CM-921 CM-921 form and instructions.pdf http://www.dol.gov/esa/regs/compliance/owcp/cm-921.pdf Yes No Fillable Printable

Income Security Survivor Compensation

DOL/ESA-6  67 FR 16869

4,000 0
   
Private Sector Businesses or other for-profits
 
   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 4,000 0 0 0 0 4,000
Annual IC Time Burden (Hours) 667 0 0 0 0 667
Annual IC Cost Burden (Dollars) 1,880 0 0 -120 0 2,000

Title Document Date Uploaded
Notice to Reviewer Note to Reviewers CM-921 (Sep 2006).pdf 01/05/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.