Information Collection

Insurance Core Survey

IC 189268 under ICR 200904-3206-007 · OMB 3206-0236.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0236 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0 Insurance Core Survey	Form
0 Insurance Website Survey PART Survey - Insurance Core Survey.doc www.opm.gov/survey/index.aspx?q=5	Form
SSB for insurance survey.doc supporting statement b	IC Document

IC Title:

Insurance Core Survey

Agency IC Tracking Number:

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
Form	0	Insurance Website Survey	PART Survey - Insurance Core Survey.doc	https://www.opm.gov/survey/index.aspx?q=5	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
supporting statement b	SSB for insurance survey.doc	05/22/2009

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