Information Collection

Inspection And Estimate/adjuster's Short Form Report/work Sheet Contents/personal Property/statement Replacement Cost Coverage/proof Of Loss/notice Of Loss

IC 151798 under ICR 198107-3067-016 · OMB 3067-0021.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3067-0021 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	INSPECTION AND ESTIMATE/ADJUSTER'S SHORT FORM REPORT/WORK SHEET CONTENTS/PERSONAL PROPERTY/STATEMENT REPLACEMENT COST COVERAGE/PROOF OF LOSS/NOTICE OF LOSS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200,000	72,857	97,143	30,000
Annual IC Time Burden (Hours)	50,000	15,000	20,000	15,000
Annual IC Cost Burden (Dollars)	0	0	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.