Information Collection

Impact of the ARRA Subsidy on COBRA Take-up Pre-screener

IC 201487 under ICR 201109-1291-001 · OMB 1291-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1291-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PART A. App_D-CBRA Screener IVR.6.1.11.pdf	Other-Survey
PART A. APP_C-Advance Letter.6.1.11.pdf Part A, Appendix C--Advance Letter	IC Document
PART B. App_B_REMINDER MALINGS.pdf Part B, Appendix B--Reminder Mailings	IC Document

IC Title:

Impact of the ARRA Subsidy on COBRA Take-up Pre-screener

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			PART A. App_D-CBRA Screener IVR.6.1.11.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	26,000	26,000
Annual IC Time Burden (Hours)	867	867
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Part A, Appendix C--Advance Letter	PART A. APP_C-Advance Letter.6.1.11.pdf	04/04/2012
Part B, Appendix B--Reminder Mailings	PART B. App_B_REMINDER MALINGS.pdf	04/04/2012

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