Information Collection

Student Health Insurance Notice Requirement

IC 200070 under ICR 201309-0938-027 · OMB 0938-1157.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1157 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Student HealthModel language.docx	Other-Notice

IC Title:

Student Health Insurance Notice Requirement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 145(d)(1) (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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Notice			Student HealthModel language.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 70

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	2,250,010	2,250,010
Annual IC Time Burden (Hours)	74,925	74,925
Annual IC Cost Burden (Dollars)	0	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.