Information Collection Request

Information Comparision with Insurance Data

ICR 201106-0970-006 · OMB 0970-0342 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Insurance Match File Form and Instruction Modified Available
Form 1 Components of an Insurance Match Agreement Form and Instruction Modified Available
Insurance_Match_PRA_Supporting_Statement_06272011FINAL.docx Supporting Statement A Uploaded 2011-06-27 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
183595 Insurance Match File Form and Instruction Modified
183594 Components of an Insurance Match Agreement Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2014 36 Months From Approved 09/30/2011
286 0 795
143 0 398
3,526 0 1,866





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Insurance Match File 1 Match File
Components of an Insurance Match Agreement 1 Insurance Match Agreement

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 286 795 0 0 -509 0
Annual Time Burden (Hours) 143 398 0 0 -255 0
Annual Cost Burden (Dollars) 3,526 1,866 0 0 1,660 0


Reginfo record details
  No