Information Collection

162.237, 437, 527, 562 - Provide information for acceptable insurance (individuals)

IC 179212 under ICR 201511-1076-001 · OMB 1076-0155.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1076-0155 can be found here:

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Information Collection (IC) Details

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IC Title:	162.237, 437, 527, 562 - Provide information for acceptable insurance (individuals)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 25 CFR 162.562 25 CFR 162.237 25 CFR 162.437 25 CFR 162.527

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,976	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,976	-5,024	10,000
Annual IC Time Burden (Hours)	1,244	-1,256	2,500
Annual IC Cost Burden (Dollars)	0	0	0

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