Information Collection

Request For Annual Report Premium Distribution, Fair Plan And Other Pools

IC 151771 under ICR 197804-3067-002 · OMB 3067-0017.

Documents and Forms

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Information Collection (IC) Details

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IC Title:	REQUEST FOR ANNUAL REPORT PREMIUM DISTRIBUTION, FAIR PLAN AND OTHER POOLS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 47	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	47	47
Annual IC Time Burden (Hours)	94	94
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.