Insurance Match File: Weekly Reporting Electronically

Information Comparision with Insurance Data

Documents and Forms

Document Name Document Type
Form 1 Insurance Match File: Weekly Reporting Electronically Form and Instruction
1 OCSE Insurance Match Standard Input File Record Insurance_Match_Standard_Input_File_Record Specifications_0970-0342_OCSS_101723.pdf Form and Instruction
1 OCSE Insurance Match Standard Input File Record Insurance_Match_Standard_Input_File_Record Specifications_0970-0342_OCSS_101723.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Insurance Match File: Weekly Reporting Electronically	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	OCSE Insurance Match Standard Input File Record	Insurance_Match_Standard_Input_File_Record Specifications_0970-0342_OCSS_101723.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: OCSE Debtor File	FR Citation: 83 FR 6591

Number of Respondents: 19	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	988	520	468
Annual IC Time Burden (Hours)	82	43	39
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.