OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 201487 under ICR 201212-1291-001 · OMB 1291-0001.

Documents and Forms
Document Name
Document Type
Other-Survey
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Impact of the ARRA Subsidy on COBRA Take-up Pre-screener
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey App_E_COBRA Screener IVR _Final.pdf Yes Yes Fillable Fileable

General Government Central Records & Statistical Mgt

 

26,000 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 26,000 0 0 0 0 26,000
Annual IC Time Burden (Hours) 867 0 0 0 0 867
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Part A, Appendix D--Advance Letter PART A APP_D-Advance Letter.pdf 12/04/2012
Part B, Appendix B--Reminder Mailings PART B. App_B_REMINDER MAILINGS.pdf 12/04/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.