Information Collection

Self-Monitoring Questionnaire for Insurance and Finance Projects

IC 35931 under ICR 201205-3420-007 · OMB 3420-0019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3420-0019 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OPIC-162 Self-Monitoring Questionnaire for Insurance and Finance Projects	Form and Instruction
OPIC-162 Self-Monitoring Questionnaire for Insurance and Finance Revised-OPIC 162 -SMQ-2012.docx	Form and Instruction

IC Title:

Self-Monitoring Questionnaire for Insurance and Finance Projects

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	OPIC-162	Self-Monitoring Questionnaire for Insurance and Finance )Projedts	Revised-OPIC 162 -SMQ-2012.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 450

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	450	100	350
Annual IC Time Burden (Hours)	1,800	-1,350	3,150
Annual IC Cost Burden (Dollars)	94,500	94,500	0

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.