Information Collection

Insurance Match File

IC 183595 under ICR 201409-0970-001 · OMB 0970-0342.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0342 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Insurance Match File	Form and Instruction
1 Match File 01 Standard Input File 08-03-07.doc	Form and Instruction

IC Title:

Insurance Match File

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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
Form and Instruction	1	Match File	01 Standard Input File 08-03-07.doc		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-264	264
Annual IC Time Burden (Hours)	-132	132
Annual IC Cost Burden (Dollars)	-2,206	2,206

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.