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

Consolidated Omnibus Budget Reconciliation Act Health Benefits Subsidy Under the American Recovery and Reinvestment Act of 2009 Evaluation

Documents and Forms

Document Name Document Type
App_E_COBRA Screener IVR _Final.pdf Other-Survey
PART A APP_D-Advance Letter.pdf Part A, Appendix D--Advance Letter IC Document
PART B. App_B_REMINDER MAILINGS.pdf Part B, Appendix B--Reminder Mailings IC Document

Information Collection (IC) Details

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: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			App_E_COBRA Screener IVR _Final.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 %

	Approved	Previously Approved
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

Title	Document	Date Uploaded
Part A, Appendix D--Advance Letter	PART A APP_D-Advance Letter.pdf	12/04/2012
Part B, Appendix B--Reminder Mailings	PART B. App_B_REMINDER MAILINGS.pdf	12/04/2012

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