Information Collection

Application for Financial Institution Short-term, Single-Buyer Insurance

IC 203931 under ICR 201209-3048-003 · OMB 3048-0019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3048-0019 can be found here:

Documents and Forms

Document Name Document Type
Form EIB 92-41 Application for Financial Institution Short-term, Single-Buyer Insurance Form and Instruction
EIB 92-41 Application for Financail Insstitution Short-Term Sinle EIB92-41-5-31-12.pdf www.exim.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Financial Institution Short-term, Single-Buyer Insurance	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320.5(a)(i)(iv)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	EIB 92-41	Application for Financail Insstitution Short-Term Sinle Buyer Insurance	EIB92-41-5-31-12.pdf	www.exim.gov	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 210

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

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	2,400	2,400
Annual IC Cost Burden (Dollars)	74,805	74,805

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.