Information Collection Request

Information Comparision with Insurance Data

ICR 201710-0970-004 · OMB 0970-0342 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Insurance Match File: Daily Reporting Manually Form and Instruction New Available
Form 1 Insurance Match File: Daily Reporting Electronically Form and Instruction New Available
Form 1 Insurance Match File: Weekly Reporting Electronically Form and Instruction New Available
Form 1 Insurance Match File: Monthly Reporting Electronically Form and Instruction New Available
Form 1 Components of an Insurance Match Agreement Form and Instruction Removed Available
2017_09_12_Insurance_Match_PRA_Supporting_Statement_0970-0342_FINAL.docx Supporting Statement A Uploaded 2017-10-05 Available
01 Standard Input File.doc Supplementary Document Uploaded 2014-09-11 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
228579 Insurance Match File: Daily Reporting Manually Form and Instruction New
228578 Insurance Match File: Daily Reporting Electronically Form and Instruction New
228577 Insurance Match File: Weekly Reporting Electronically Form and Instruction New
228576 Insurance Match File: Monthly Reporting Electronically Form and Instruction New
183594 Components of an Insurance Match Agreement Form and Instruction Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2021 36 Months From Approved 01/31/2018
21,210 0 336
2,102 0 168
0 0 1,680





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 21,210 336 0 20,874 0 0
Annual Time Burden (Hours) 2,102 168 0 1,934 0 0
Annual Cost Burden (Dollars) 0 1,680 0 -1,680 0 0


Reginfo record details
  No