Information Collection

Insurers

IC 186143 under ICR 200808-0990-002 · OMB 0990-0333.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-PLTC Reporting Instructions.doc	Instruction
0990-PLTC File Specifications.xls 0990-PLTC File Specifications	IC Document

IC Title:

Insurers

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			0990-PLTC Reporting Instructions.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Partnership for Long Term Care Data Set

FR Citation: 73 FR 30030

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	12,000	12,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-PLTC File Specifications	0990-PLTC File Specifications.xls	08/12/2008

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