Information Collection

Impact of the ARRA Subsidy on COBRA Take-up Pre-screener

IC 201487 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⚠️ Notice: This information collection may be referencing outdated material.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_D-CBRA Screener IVR.6.1.11.pdf Other-Survey
PART A. APP_C-Advance Letter.6.1.11.pdf Part A, Appendix C--Advance Letter IC Document
PART B. App_B_REMINDER MALINGS.pdf Part B, Appendix B--Reminder Mailings IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Impact of the ARRA Subsidy on COBRA Take-up Pre-screener	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_D-CBRA Screener IVR.6.1.11.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: 26,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	26,000	26,000
Annual IC Time Burden (Hours)	867	867
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Part A, Appendix C--Advance Letter	PART A. APP_C-Advance Letter.6.1.11.pdf	04/04/2012
Part B, Appendix B--Reminder Mailings	PART B. App_B_REMINDER MALINGS.pdf	04/04/2012

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