Information Collection

Standard Reinsurance Agreement

IC 1632 under ICR 202402-0563-002 · OMB 0563-0069.

Documents and Forms

Document Name Document Type
Form Business Pandemic Standard Reinsurance Agreement Form
Business Pandemic Business Pandemic Influenza Planning Checklist 25 - Business Pandemic Influenza Planning Checklist.pdf Form
Business Pandemic Business Pandemic Influenza Planning Checklist 25 - Business Pandemic Influenza Planning Checklist.pdf Form
Exhibit IIIG1-3 Loss Adjust Expense Template 25 - SRA EX IIIG1-3 - Loss Adjustment Expense Template.pdf Form
Exhibit IIIG1-3 Loss Adjust Expense Template 25 - SRA EX IIIG1-3 - Loss Adjustment Expense Template.pdf Form
Exhibit IVh2B SRA and LPRA Escrow Agreement with Bank 25 - SRA EX IVh2B - SRA and LPRA Escrow Agreement with Bank.pdf Form
Exhibit IVh2B SRA and LPRA Escrow Agreement with Bank 25 - SRA EX IVh2B - SRA and LPRA Escrow Agreement with Bank.pdf Form
Exhibit IVh1B SRA and LPRA Escrow Agreement with Reinsured Company 25 - SRA EX IVh1B - SRA and LPRA Escrow Agreement with Reinsured Company.pdf Form
Exhibit IVh1B SRA and LPRA Escrow Agreement with Reinsured Company 25 - SRA EX IVh1B - SRA and LPRA Escrow Agreement with Reinsured Company.pdf Form
Exhibit 1A-C and V Plan of Operations Template 25 - SRA EX IA-C and VA-C Plan of Operations Template.xlsx Form
Exhibit 1A-C and V Plan of Operations Template 25 - SRA EX IA-C and VA-C Plan of Operations Template.xlsx Form
Exhibit IIIF1-3 Agent Compensation Template 25 - SRA EX IIIF1-3 - Agent Compensation Template.pdf Form
Exhibit IIIF1-3 Agent Compensation Template 25 - SRA EX IIIF1-3 - Agent Compensation Template.pdf Form
Exhibit IIIH1-3 Total Expense Template 25 - SRA EX IIIH1-3 - Total Expense Template.pdf Form
Exhibit IIIH1-3 Total Expense Template 25 - SRA EX IIIH1-3 - Total Expense Template.pdf Form
Exhibit IVh1A Escrow Agreement with Reinsured Company 25 - SRA EX IVh1A - SRA Escrow Agreement with Reinsured Company.pdf Form
Exhibit IVh1A Escrow Agreement with Reinsured Company 25 - SRA EX IVh1A - SRA Escrow Agreement with Reinsured Company.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?	Can Be Submitted Electronically?	Electronic Capability
Form	Business Pandemic Influenza Planning Checklist	Business Pandemic Influenza Planning Checklist	25 - Business Pandemic Influenza Planning Checklist.pdf	Yes	Yes	Fillable Fileable Signable
Form	Exhibit IIIG1-3	Loss Adjust Expense Template	25 - SRA EX IIIG1-3 - Loss Adjustment Expense Template.pdf	Yes	Yes	Fillable Fileable Signable
Form	Exhibit IVh2B	SRA and LPRA Escrow Agreement with Bank	25 - SRA EX IVh2B - SRA and LPRA Escrow Agreement with Bank.pdf	Yes	Yes	Fillable Fileable Signable
Form	Exhibit IVh1B	SRA and LPRA Escrow Agreement with Reinsured Company	25 - SRA EX IVh1B - SRA and LPRA Escrow Agreement with Reinsured Company.pdf	Yes	Yes	Fillable Fileable Signable
Form	Exhibit 1A-C and VA-C	Plan of Operations Template	25 - SRA EX IA-C and VA-C Plan of Operations Template.xlsx	Yes	Yes	Fillable Fileable Signable
Form	Exhibit IIIF1-3	Agent Compensation Template	25 - SRA EX IIIF1-3 - Agent Compensation Template.pdf	Yes	Yes	Fillable Fileable Signable
Form	Exhibit IIIH1-3	Total Expense Template	25 - SRA EX IIIH1-3 - Total Expense Template.pdf	Yes	Yes	Fillable Fileable Signable
Form	Exhibit IVh1A	Escrow Agreement with Reinsured Company	25 - SRA EX IVh1A - SRA Escrow Agreement with Reinsured Company.pdf	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22,013	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	56,598	454	56,144
Annual IC Time Burden (Hours)	197,458	8,458	189,000
Annual IC Cost Burden (Dollars)	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.