OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

SIPP 2014 Panel

IC 208349 under ICR 201608-0607-003 · OMB 0607-0977.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form Items Booklet
Items Booklet SIPP 2014 Panel		 Form
Form EHC
EHC SIPP 2014 Panel		 Form
B-SIPP-105(L1)(2014) Attachment B.pdf Other-SIPP-105(L1)2014–Director's Le
C-SIPP-105(L1)(SP)(2014) Attachment C.pdf Other-SIPP-105(L1)(SP)2014–Spanish D
SIPP-105(L2)(2014) revised incentive statement.pdf Other-SIPP-105(L2)2014–Director's Le
SIPP-105(L3)(2014) revised incentive statement.pdf Other-SIPP-105(L3)2014–Director's Le
F-SIPP Respondent Rules - Attachment F.pdf Other-Respondent Rules
G-SIPP Respondent Rules - Attachment G (Spanish).pdf Other-Respondent Rules (Spanish)
H-SIPP 101_Factsheet [Attachment H].pdf Other-SIPP Fact Sheet
I-SIPP_Health Insurance_Brochure Attachment I.pdf Other-SIPP Brochure: Health Insuranc
J-SIPP_Families with Children Brochure Attachment J.pdf Other-SIPP Brochure: Families with C
K-SIPP_Labor Force_Brochure Attachment K.pdf Other-SIPP Brochure: Labor Force and
L-SIPP in the News_Attachment L.pub Other-SIPP In the News
M-sipp_inf1_2014 Attachment M.pdf Other-SIPP-INF1-2014 Incentive Flyer
N-sipp_inf2_2014 - Attachment N.pdf Other-SIPP-INF2-2014 Incentive Flyer
O-sipp_pin_2014 Attachment O.pdf Other-SIPP PIN letter
Items Booklet Items Booklet
A-2014 SIPP Items Booklet - Attachment A Part 1.pdf 		Form
EHC EHC
A-2014 SIPP Items Booklet - Attachment A Part 2 (EHC).pdf 		Form

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 Items Booklet Yes Yes Fillable Fileable
Form EHC Yes Yes Fillable Fileable
Other-SIPP-105(L1)2014–Director's Letter Yes Yes Fillable Fileable
Other-SIPP-105(L1)(SP)2014–Spanish Director's Letter Yes Yes Fillable Fileable
Other-SIPP-105(L2)2014–Director's Letter with $20 incentive Yes Yes Fillable Fileable
Other-SIPP-105(L3)2014–Director's Letter with $40 incentive Yes Yes Fillable Fileable
Other-Respondent Rules Yes Yes Fillable Fileable
Other-Respondent Rules (Spanish) Yes Yes Fillable Fileable
Other-SIPP Fact Sheet Yes Yes Fillable Fileable
Other-SIPP Brochure: Health Insurance Yes Yes Fillable Fileable
Other-SIPP Brochure: Families with Children Yes Yes Fillable Fileable
Other-SIPP Brochure: Labor Force and Employment Yes Yes Fillable Fileable
Other-SIPP In the News Yes Yes Fillable Fileable
Other-SIPP-INF1-2014 Incentive Flyer for Director’s Letter $40 Yes Yes Fillable Fileable
Other-SIPP-INF2-2014 Incentive Flyer for Director’s Letter $20 Yes Yes Fillable Fileable
Other-SIPP PIN letter Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 73,500 0 0 0 0 73,500
Annual IC Time Burden (Hours) 73,500 0 0 0 0 73,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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