Information Collection

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

IC 203931 under ICR 201512-3048-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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 EIB 92-41, Application for Financial Institution Short-T EIB92-41.pdf www.exim.gov/pub/pending/EIB92-41.pdf 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: Unchanged

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	EIB 92-41, Application for Financial Institution Short-Term, Single-Buyer Insurance	EIB92-41.pdf	http://www.exim.gov/pub/pending/EIB92-41.pdf	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: 215	Number of Respondents for Small Entity: 180

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

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	215	215
Annual IC Time Burden (Hours)	344	344
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.