Information Collection

Insurance Match File: Daily Reporting Manually

IC 228579 under ICR 202311-0970-003 · OMB 0970-0342.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0342 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
IM DI Portal Screens_Manual_Reporting_102023.pdf	Other-Daily Reporting Manual Submiss
IM DI Portal Screens_Manual_Reporting_102023.pdf	Other-Daily Reporting Manual Submiss

IC Title:

Insurance Match File: Daily Reporting Manually

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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
Other-Daily Reporting Manual Submission			IM DI Portal Screens_Manual_Reporting_102023.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: OCSE Debtor File

FR Citation: 83 FR 6591

Number of Respondents: 118

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	29,618	2,510	27,108
Annual IC Time Burden (Hours)	2,962	251	2,711
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.