Information Collection

Early Retiree Reinsurance Program - Public Application

IC 192754 under ICR 201009-0938-016 · OMB 0938-1087.

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Information Collection (IC) Details

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IC Title:	Early Retiree Reinsurance Program - Public Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 149.40

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Early Retirement Reinsurance Program	FR Citation: 75 FR 31440

Number of Respondents: 2,700	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,700	1,200	1,500
Annual IC Time Burden (Hours)	59,400	6,900	52,500
Annual IC Cost Burden (Dollars)	0	0	0

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