Information Collection

TRIP Recoupment Reporting and Remittance

IC 186494 under ICR 201205-1505-005 · OMB 1505-0207.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TRIP 04A TRIP Recoupment Reporting and Remittance	Form
TRIP form 04A monthly calculation instructions 6June2012.doc	Instruction
TRIP Form 04B surcharge instructions 7June2012.doc	Instruction
TRIP 04A DIRECT WRITTEN PREMIUM AND MONTHLY SURCHARGE CALCULATION TRIP form 04A monthly calculation 6June2012.doc	Form
TRIP 04B ?DIRECT WRITTEN PREMIUM AND END OF YEAR CALCULATION TRIP Form 04B Surcharge 7June2012.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 31 CFR Subpart 50 H (to be added) (To search for a specific CFR, visit the Code of Federal Regulations.)

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	TRIP 04A	DIRECT WRITTEN PREMIUM AND MONTHLY SURCHARGE CALCULATION	TRIP form 04A monthly calculation 6June2012.doc	Yes	Yes	Fillable Fileable Signable
Instruction			TRIP form 04A monthly calculation instructions 6June2012.doc	Yes	Yes	Fillable Fileable Signable
Form	TRIP 04B	ÂDIRECT WRITTEN PREMIUM AND END OF YEAR CALCULATION	TRIP Form 04B Surcharge 7June2012.doc	Yes	Yes	Fillable Fileable Signable
Instruction			TRIP Form 04B surcharge instructions 7June2012.doc	Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	24,000	24,000
Annual IC Time Burden (Hours)	120,000	120,000
Annual IC Cost Burden (Dollars)	8,400,000	8,400,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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