Information Collection

Standard Reinsurance Agreement

IC 1632 under ICR 201404-0563-001 · OMB 0563-0069.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0563-0069 can be found here:

Documents and Forms

Document Name Document Type
Standard Reinsurance Agreement Form
Business Pandemic Influenza Checklist - Appendix II business-pandemic-influenza.pdf Form
Exhibit V.c: Commercial Fund Template CommericalFundTemplate.pdf Form
Exhibit IV.h.2: Escrow Agreement with Bank EscrowAgreementwBank.pdf Form
Exhibit IV.h.1: Escrow Agreement with Reinsured Company EscrowAgreementwReinsuredCompany.pdf Form
Exhibit III.h.1-3: Total Expense TotalExpense.pdf Form
Exhibit III.g.1-3: Loss Adjustment Expense Template LossAdjustmentExpenseTemplate.pdf Form
Exhibit III.f.1-3Agent Comp Template AgentCompTemplate.pdf Form
Exhibit V.b: Estimated Premium Template EstimatedPremiumTemplate.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Standard Reinsurance Agreement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 1508 (k)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	N/A	Business Pandemic Influenza Checklist - Appendix II	business-pandemic-influenza.pdf	No	Paper Only
Form	N/A	Exhibit V.c: Commercial Fund Template	CommericalFundTemplate.pdf	No	Paper Only
Form	N/A	Exhibit IV.h.2: Escrow Agreement with Bank	EscrowAgreementwBank.pdf	No	Paper Only
Form	N/A	Exhibit IV.h.1: Escrow Agreement with Reinsured Company	EscrowAgreementwReinsuredCompany.pdf	No	Paper Only
Form	N/A	Exhibit III.h.1-3: Total Expense	TotalExpense.pdf	No	Paper Only
Form	N/A	Exhibit III.g.1-3: Loss Adjustment Expense Template	LossAdjustmentExpenseTemplate.pdf	No	Paper Only
Form	N/A	Exhibit III.f.1-3Agent Comp Template	AgentCompTemplate.pdf	No	Paper Only
Form	N/A	Exhibit V.b: Estimated Premium Template	EstimatedPremiumTemplate.pdf	No	Paper Only

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,019	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50,874	-15,016	-4,362	70,252
Annual IC Time Burden (Hours)	173,200	-15,384	12,900	175,684
Annual IC Cost Burden (Dollars)	0	0	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.