Information Collection

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

IC 201487 under ICR 201212-1291-001 · OMB 1291-0001.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.