Information Collection

Terrorism Risk Insurance Program Loss Reporting

IC 39047 under ICR 201009-1505-001 · OMB 1505-0200.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0200 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TRIP 01 Terrorism Risk Insurance Program Loss Reporting	Form and Instruction
Schedule C Instructions 19Nov2010.doc	Instruction
TRIP 01 Initial Notice of Insured Loss Initial Notice of Loss Revised 19Nov2010.doc	Form and Instruction
TRIP 02 Certification of Loss Certification of Loss Revised 19Nov2010.doc	Form and Instruction
TRIP 02A Schedule A Schedule A Revised 19Nov2010.doc	Form and Instruction
TRIP 02B Schedule B Schedule B Revised 19Nov2010.doc	Form and Instruction
TRIP 02C Schedule C Bordereau Schedule C 28Sept2010.xls	Form
Initial Notice of Loss Revised 19Nov2010.doc Initial Notice of Insured Loss	IC Document
Certification of Loss Revised 19Nov2010.doc Certification of Loss	IC Document
Schedule A Revised 19Nov2010.doc Schedule A	IC Document
Schedule B Revised 19Nov2010.doc Schedule B	IC Document
Schedule C 28Sept2010.xls Schedule C Bordereau	IC Document
Schedule C Instructions 19Nov2010.doc Schedule C Instructions	IC Document

IC Title:

Terrorism Risk Insurance Program Loss Reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	TRIP 01	Initial Notice of Insured Loss	Initial Notice of Loss Revised 19Nov2010.doc	Yes	Yes	Fillable Fileable
Form and Instruction	TRIP 02	Certification of Loss	Certification of Loss Revised 19Nov2010.doc	Yes	Yes	Fillable Fileable
Form and Instruction	TRIP 02A	Schedule A	Schedule A Revised 19Nov2010.doc	Yes	Yes	Fillable Fileable
Form and Instruction	TRIP 02B	Schedule B	Schedule B Revised 19Nov2010.doc	Yes	Yes	Fillable Fileable
Form	TRIP 02C	Schedule C Bordereau	Schedule C 28Sept2010.xls	Yes	Yes	Fillable Fileable
Instruction			Schedule C Instructions 19Nov2010.doc	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	4,200	4,200
Annual IC Cost Burden (Dollars)	1,100,000	1,100,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Initial Notice of Insured Loss	Initial Notice of Loss Revised 19Nov2010.doc	11/19/2010
Certification of Loss	Certification of Loss Revised 19Nov2010.doc	11/19/2010
Schedule A	Schedule A Revised 19Nov2010.doc	11/19/2010
Schedule B	Schedule B Revised 19Nov2010.doc	11/19/2010
Schedule C Bordereau	Schedule C 28Sept2010.xls	11/19/2010
Schedule C Instructions	Schedule C Instructions 19Nov2010.doc	11/19/2010

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