Information Collection

Survey of Nonparticipating Single-Premium Group Annuity Rates

IC 13545 under ICR 201503-1212-001 · OMB 1212-0030.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0030 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ACLI SURVEY to OMB 2015.doc	Instruction
Supporting Statement Part A 2015 Final.docx Supporting Statement Part A	IC Document
Supporting Statement Part B 2015 Final.docx Supporting Statement Part B	IC Document

IC Title:

Survey of Nonparticipating Single-Premium Group Annuity Rates

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
Instruction			ACLI SURVEY to OMB 2015.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

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
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	24	0	24
Annual IC Time Burden (Hours)	12	0	12
Annual IC Cost Burden (Dollars)	0	-360	360

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Part A	Supporting Statement Part A 2015 Final.docx	03/09/2015
Supporting Statement Part B	Supporting Statement Part B 2015 Final.docx	03/09/2015

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