Information Collection

Student Health Insurance Notice Requirement

IC 200070 under ICR 201309-0938-027 · OMB 0938-1157.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1157 can be found here:

Documents and Forms

Document Name Document Type
Student HealthModel language.docx Other-Notice

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Student Health Insurance Notice Requirement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 145(d)(1) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Notice			Student HealthModel language.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	2,250,010	2,250,010
Annual IC Time Burden (Hours)	74,925	74,925
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.