Information Collection

Federal Crime Insurance Program Crime Insurance Applications - Proof Of Loss

IC 151862 under ICR 198212-3067-003 · OMB 3067-0031.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3067-0031 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	FEDERAL CRIME INSURANCE PROGRAM CRIME INSURANCE APPLICATIONS - PROOF OF LOSS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	FEMA 81-12	No	No
Form	FEMA 81-14	No	No
Form	HUD-1640	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	21,500	16,500	5,000
Annual IC Time Burden (Hours)	5,375	4,125	1,250
Annual IC Cost Burden (Dollars)	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.