Information Collection

Notice Of Loss, Adjuster's Report: Part 1, Part 2 & Part 3, Worksheet - Contents - Personal Property, Worksheet Building, Worksheet - Building (cont'd), Proof Of Loss

IC 175672 under ICR 198510-3067-001 · OMB 3067-0021.

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Information Collection (IC) Details

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IC Title:	NOTICE OF LOSS, ADJUSTER'S REPORT: PART 1, PART 2 & PART 3, WORKSHEET - CONTENTS - PERSONAL PROPERTY, WORKSHEET BUILDING, WORKSHEET - BUILDING (CONT'D), 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.	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: 41,208	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	Previously Approved
Annual Number of Responses for this IC	25,900	-26,730	52,630
Annual IC Time Burden (Hours)	98,420	-69,274	167,694
Annual IC Cost Burden (Dollars)	0	0	0

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