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 175673 under ICR 198603-3067-004 · 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: 39,475	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	39,475	13,575	25,900
Annual IC Time Burden (Hours)	150,000	51,580	98,420
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.