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Federal forms, ICRs, and supporting documents

Information Collection Request

POLICIES AND PRACTICES OF INSURANCE CARRIERS AFFECTING APPLICANTS FOR GROUP INSURANCE

ICR 198003-1215-002 · OMB 1215-0096 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
122139 POLICIES AND PRACTICES OF INSURANCE CARRIERS AFFECTING APPLICANTS FOR GROUP INSURANCE Form Migrated
ICR Details
1215-0096 198003-1215-002
Historical Active
DOL/ESA
POLICIES AND PRACTICES OF INSURANCE CARRIERS AFFECTING APPLICANTS FOR GROUP INSURANCE
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/08/1980
Retrieve Notice of Action (NOA) 03/13/1980
  Inventory as of this Action Requested Previously Approved
09/30/1980 09/30/1980
150 0 0
50 0 0
0 0 0

None
None
No
1
IC Title Form No. Form Name
POLICIES AND PRACTICES OF INSURANCE CARRIERS AFFECTING APPLICANTS FOR GROUP INSURANCE ESA-80(T)
  Total Approved 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 150 0 0 0 150 0
Annual Time Burden (Hours) 50 0 0 0 50 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/13/1980