Information Collection

Application for Financial Institution Short-term, Single-Buyer Insurance

IC 203931 under ICR 201209-3048-003 · OMB 3048-0019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3048-0019 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EIB 92-41 Application for Financial Institution Short-term, Single-Buyer Insurance	Form and Instruction
EIB 92-41 Application for Financail Insstitution Short-Term Sinle EIB92-41-5-31-12.pdf www.exim.gov	Form and Instruction

IC Title:

Application for Financial Institution Short-term, Single-Buyer Insurance

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320.5(a)(i)(iv)

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	EIB 92-41	Application for Financail Insstitution Short-Term Sinle Buyer Insurance	EIB92-41-5-31-12.pdf	www.exim.gov	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 210

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	2,400	2,400
Annual IC Cost Burden (Dollars)	74,805	74,805

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.