Insurers

Partnership for Long Term Care Insurer Reporting Requirements

Documents and Forms

Document Name Document Type
0990-PLTC Reporting Instructions.doc Instruction
0990-PLTC File Specifications.xls 0990-PLTC File Specifications IC Document

Information Collection (IC) Details

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:

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 %

	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

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.