Information Collection

COBRA Subsidy Study

IC 199766 under ICR 201109-1291-001 · OMB 1291-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1291-0001 can be found here:

Documents and Forms

Document Name Document Type
PART A. APP_E_COBRA Subsidy Study Survey (7-20-11 dab)-q17.pdf Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	COBRA Subsidy Study	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			PART A. APP_E_COBRA Subsidy Study Survey (7-20-11 dab)-q17.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,800	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
Annual Number of Responses for this IC	5,800	5,800
Annual IC Time Burden (Hours)	4,350	4,350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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