Information Collection Request

Information Comparision with Insurance Data

ICR 200801-0970-006 · OMB 0970-0342 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Components of an Insurance Match Agreement Form and Instruction New Available
03 Supporting Stmt Insurance Match_10 16 07_vfinal.doc Supporting Statement A Uploaded 2007-12-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
183595 Insurance Match File Other-File New
183594 Components of an Insurance Match Agreement Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2011 36 Months From Approved
795 0 0
398 0 0
1,866 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Components of an Insurance Match Agreement 1 Insurance Match Agreement
Insurance Match File

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 795 0 0 795 0 0
Annual Time Burden (Hours) 398 0 0 398 0 0
Annual Cost Burden (Dollars) 1,866 0 0 1,866 0 0


Reginfo record details
  No