Insurance Core Survey

Generic Customer Satisfaction

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Insurance Core Survey	Agency IC Tracking Number:

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
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 %

	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

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.