SRA Grid

INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. (D), (F), (H), (I), and (K) should be entered in items 17 & 18 of SF-83. For cols. (E), (G), and (J), the averages of the totals shall be computed, as follows, and then entered on the SF-83. (F) Total = (E) Average (H) Total = (G) Average (K) Total = (J) Average (D) Total (F) Total (I) Total		TITLE OF INFORMATION COLLECTION DOCUMENT Standard Reinsurance Agreement					OMB NO. 0563-0069			PAGE 1 of 2
							DATE PREPARED: 8/23/17
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT		FORM NO(S) (If "none", so state)	ANNUAL BURDEN
SECTION OF REGS	DESCRIPTION		REPORTS					RECORDS
			NO. OF RESPONDENTS	NO. OF RESPONSES PER RESPONDENT	TOTAL ANNUAL RESPONSES (Col. D x E)	HOURS PER RESPONSE	TOTAL HOURS (Col. F x G)	NO. OF RECORDKEEPERS	ANNUAL HOURS OF RECORDKEEPING	TOTAL RECORDKEEPING HOURS (Col.I x J)
(A)	(B)	(C)	(D)	(E )	(F)	(G)	(H)	(I)	(j)	(K)
7 CFR Ch. IV -	APPENDIX I
Subpart L	Conflict of Interest Disclosure
	Section VI(e) - Agents, Adjusters, and Employees		20000	1	20000	1	20000
	Section VI(e) - AIPs		16	1	16	24	384
	Controlled Business Certification
	Section VII(b) - Agents		12500	1	12500	1	12500
	Section VII(b) - AIP Reporting		16	1	16	24	384
	APPENDIX II
	Section I(a)		16	1	16	1	16
	Section I(b)		16	1	16	1	16
	Section I(c)		16	1	16	1	16
	Section II(a)		16	1	16	1	16
	Section II(b)		16	1	16	1	16
	Section II(c)		16	1	16	1	16
	Section II(d)		16	1	16	1	16
	Section II(e)		16	1	16	1	16
	Section II(f)		16	1	16	1	16
	Section II(g)		16	1	16	1	16
	Section II(h)		16	1	16	1	16
	Section III(b)		16	1	16	2	32
	Section III(c)		16	1	16	2	32
	Section III(d)		16	1	16	8	128
	Section III(e)		16	1	16	1	16
	Section III(f)		16	1	16	16	256
	Section III(g)		16	1	16	16	256
	Section III(h)		16	1	16	8	128
	Section III(i)		16	1	16	1	16
	Section IV(a)		16	1	16	1	16
	Section IV(b)		16	1	16	1	16
	Section IV(c)		16	1	16	1	16
	Section IV(d)		16	1	16	1	16
	Section IV(e)		16	1	16	1	16
	Section IV(f)		16	1	16	1	16
	Section IV(g)		16	1	16	1	16
	Section IV(h)		16	1	16	1	16
	Section IV(i)		16	1	16	1	16
	Section IV(j)		16	1	16	1	16
	Section IV(k)		16	1	16	1	16
	Section IV(l)		16	1	16	1	16
	Section IV(m)		16	1	16	4	64
	Section IV(n)		16	1	16	4	64
	Section V(a)		16	1	16	1	16
	Section V(b)		16	1	16	8	128
	Section V(c )		16	1	16	1	16
	Section V(d)		16	1	16	1	16
	Section VI(a)		16	1	16	8	128
	Section VI(b)		16	1	16	12	192
	Section VI(c)		16	1	16	8	128
	Section VI(d)		16	1	16	4	64
	AIP App. II Total					128	2048
	APPENDIX IV
	Section I(a) - QC Plan, App II section VI(j)		16	1	16	20	320
	Section II(a) - TPEP/TEPR, App II section VI(i)		16	1	16	30	480
	Section III(a) - QC report		16	1	16	24	384
	AIP App. IV Total					74	1184
	Section II(d)(1) - Agent training hours		12500	1	12500	4	50000
	Section II(d)(2) - Loss Adjuster training hours		5000	1	5000	17	85000
	Totals				50736		171500