Information Collection

Application for Financial Institution Short-term, Single-Buyer Insurance

IC 203931 under ICR 201503-3048-005 · OMB 3048-0019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3048-0019 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EIB 92-41 Application for Financial Institution Short-term, Single-Buyer Insurance	Form and Instruction
EIB 92-41 EIB 92-41, Application for Financial Institution Short-T EIB92-41.pdf www.exim.gov/pub/pending/EIB92-41.pdf	Form and Instruction

IC Title:

Application for Financial Institution Short-term, Single-Buyer Insurance

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320.5(a)(i)(iv)

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	EIB 92-41	EIB 92-41, Application for Financial Institution Short-Term, Single-Buyer Insurance	EIB92-41.pdf	http://www.exim.gov/pub/pending/EIB92-41.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 215

Number of Respondents for Small Entity: 180

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	215	-85	300
Annual IC Time Burden (Hours)	344	-2,056	2,400
Annual IC Cost Burden (Dollars)	0	-74,805	74,805

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.