Information Collection

Recoupment Provisions

IC 227208 under ICR 202009-1505-001 · OMB 1505-0200.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0200 can be found here:

Documents and Forms

Document Name Document Type
TRIP Form 04A Monthly Recoupment Calculation Instructions.doc tripclaims.treas.gov/TRIP/ Instruction
TRIP Form 04B End of Year Recoupment Calculation Instructions.doc Direct Written Premium and Monthly Surcharge Calcu Instruction
TRIP 04A Direct Written Premium and Monthly Surcharge Calculation TRIP Form 04A Monthly Recoupment Calculation.doc tripclaims.treas.gov/TRIP/ Form
TRIP 04B Direct Written Premium and End of Year Calcuation TRIP Form 04B End of Year Recoupment Calculation.doc tripclaims.treas.gov/TRIP/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Recoupment Provisions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 31 CFR 50

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			TRIP Form 04A Monthly Recoupment Calculation Instructions.doc	https://tripclaims.treas.gov/TRIP/	Yes	Yes	Fillable Fileable
Form	TRIP 04A	Direct Written Premium and Monthly Surcharge Calculation	TRIP Form 04A Monthly Recoupment Calculation.doc	https://tripclaims.treas.gov/TRIP/	Yes	Yes	Fillable Fileable
Instruction			TRIP Form 04B End of Year Recoupment Calculation Instructions.doc	Direct Written Premium and Monthly Surcharge Calcu	Yes	Yes	Fillable Fileable
Form	TRIP 04B	Direct Written Premium and End of Year Calcuation	TRIP Form 04B End of Year Recoupment Calculation.doc	https://tripclaims.treas.gov/TRIP/	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: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	24,000	0	24,000
Annual IC Time Burden (Hours)	120,000	0	120,000
Annual IC Cost Burden (Dollars)	0	-8,400,000	8,400,000

Documents for IC

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.