Information Collection Request

RUIA Claims Notification and Verification System

ICR 201111-3220-001 · OMB 3220-0171 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form ID-4K RUIA Claims Notification System Form Modified Available
3220-0171.doc Supporting Statement A Uploaded 2011-11-15 Available
ERS Log on screen.pdf Supplementary Document Uploaded 2008-09-30 Available
ERS Entry screen.pdf Supplementary Document Uploaded 2008-09-30 Available
Circular Letter U.I.C.229.pdf Supplementary Document Uploaded 2011-11-15 Available
BA-12 (05-09).pdf Supplementary Document Uploaded 2011-11-15 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
33972 RUIA Claims Notification System Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2014 36 Months From Approved 12/31/2011
77,935 0 18,700
2,001 0 339
0 0 0





Reginfo record details
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table that charts list of burden
IC Title Form No. Form Name
RUIA Claims Notification System ID-4K, ID-4K(INTERNET), ID-4E (Internet), ID-4E(INTERNET) Prepayment Claims Verification Notice ,   Notice of RUIA Claim Determination ,   Prepayment Claims Verification Notice (Internet) ,   Notice of RUIA Claim Determination

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 77,935 18,700 0 0 59,235 0
Annual Time Burden (Hours) 2,001 339 0 0 1,662 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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