Information Collection Request

Form 2587 - Application for Special Enrollment Examination

ICR 202107-1545-010 · OMB 1545-0949 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 2587 Form 2587--Application for Special Enrollment Examination Form and Instruction Modified Missing upstream
1545-0949 SS 2021.docx Supporting Statement A Uploaded 2021-12-31 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
39887 Form 2587--Application for Special Enrollment Examination Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 12/31/2021
15,643 11,000
1,564 1,100
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Form 2587--Application for Special Enrollment Examination 2587 Application for Special Enrollment Examination

table that charts list of burden
  Total Request 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 15,643 11,000 0 0 4,643 0
Annual Time Burden (Hours) 1,564 1,100 0 0 464 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No