Information Collection

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

IC 175669 under ICR 198309-3067-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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/ WORKSHEET 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: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	(UNDER	No	No
Form	REVISION)	No	No
Form	FEMA FORM	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	0	0	200,000
Annual IC Time Burden (Hours)	276,000	19,000	207,000	50,000
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.