Information Collection

Application to Participate as a Carrier of a Comprehensive Medical Plan in the Federal Employees Health Benefits Program

IC 33620 under ICR 199612-3206-001 · OMB 3206-0145.

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Information Collection (IC) Details

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IC Title:	Application to Participate as a Carrier of a Comprehensive Medical Plan in the Federal Employees Health Benefits Program	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: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

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	50	1	0	49
Annual IC Time Burden (Hours)	4,500	-9,030	0	13,530
Annual IC Cost Burden (Dollars)	101,000	0	101,000	0

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