Information Collection

Chief actuary at health insurance companies

IC 198796 under ICR 201108-0990-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990- IMR insurer survey.docx	Other-survey
0990-IMR carrier survey advance letter.docx 0990-IMR carrier survey advance letter	IC Document
0990- IMR respondent worksheet.docx 0990- IMR respondent worksheet	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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
Other-survey			0990- IMR insurer survey.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 408

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	408	408
Annual IC Time Burden (Hours)	306	306
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-IMR carrier survey advance letter	0990-IMR carrier survey advance letter.docx	08/08/2011
0990- IMR respondent worksheet	0990- IMR respondent worksheet.docx	08/08/2011

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