Information Collection

Insurance Match File: Quarterly Reporting Electronically

IC 263231 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 1 Insurance Match File: Quarterly Reporting Electronically	Form and Instruction
1 OCSE Insurance Match Standard Input File Record Insurance_Match_Standard_Input_File_Record Specifications_0970-0342_OCSS_101723.pdf	Form and Instruction
1 OCSE Insurance Match Standard Input File Record Insurance_Match_Standard_Input_File_Record Specifications_0970-0342_OCSS_101723.pdf	Form and Instruction

IC Title:

Insurance Match File: Quarterly Reporting Electronically

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form and Instruction	1	OCSE Insurance Match Standard Input File Record	Insurance_Match_Standard_Input_File_Record Specifications_0970-0342_OCSS_101723.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: 1

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	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.