Forms and Documents

Document Name	Status
Type 70 - Book of Business Record.pdf Supplementary Document	2022-11-30
Type 35 - Personal Projected Price Record.pdf Supplementary Document	2022-11-30
Type 29 - DRP Coverage Inquiry Record.pdf Supplementary Document	2022-11-30
Type 28 - DRP Indemnity Record.pdf Supplementary Document	2022-11-30
Type 25 LRP Indemnity Record.pdf Supplementary Document	2022-11-30
Type 24 - LGM Indemity Record.pdf Supplementary Document	2022-11-30
Type 18 - DRP Premium Record.pdf Supplementary Document	2022-11-30
Type 17 - LRP Premium Record.pdf Supplementary Document	2022-11-30
P16_1_Plan_82_Premium_Calculation.pdf Supplementary Document	2022-11-30
Documents-and-Supplemental-Standards-Handbook.pdf Supplementary Document	2022-11-30
Burden Grid 2022 0563-0053.xlsx Supplementary Document	2022-11-30
2022 Supporting Statement 0563-0053 11-30-22.docx Supporting Statement A	2022-11-30
60-day notice.pdf Supplementary Document	2022-11-15
Act.pdf Supplementary Document	2019-07-01
Type 75 - Producer Certification Record.pdf Supplementary Document	2019-06-25
Type 58 - Notice of Loss Record.pdf Supplementary Document	2019-06-25
Type 57 - Quality Control Reporting Record.pdf Supplementary Document	2019-06-25
Type 56 - Adjuster Record.pdf Supplementary Document	2019-06-25
Type 55 - Insurance Agent Record.pdf Supplementary Document	2019-06-25
Type 54 - Employee Record.pdf Supplementary Document	2019-06-25
Type 51 - Conflict of Interest Record.pdf Supplementary Document	2019-06-25
Type 49 - Policy Delete Record.pdf Supplementary Document	2019-06-25
Type 48 - Record Type Delete Record.pdf Supplementary Document	2019-06-25
Type 27 - Land Record.pdf Supplementary Document	2019-06-25
Type 26 - Production Record.pdf Supplementary Document	2019-06-25
Type 23 - WFRP Indemnity Record.pdf Supplementary Document	2019-06-25
Type 22 - Inventory Loss Detail Record.pdf Supplementary Document	2019-06-25
Type 21 - Production Loss Detail Record.pdf Supplementary Document	2019-06-25
Type 20 - Loss Total Record.pdf Supplementary Document	2019-06-25
Type 19 - WFRP Farm Reports Record.pdf Supplementary Document	2019-06-25
Type 15 - Yield Record.pdf Supplementary Document	2019-06-25
Type 14 - Insurance In Force Record.pdf Supplementary Document	2019-06-25
Type 13 - Inventory Value Record.pdf Supplementary Document	2019-06-25
Type 12 - Payment Record.pdf Supplementary Document	2019-06-25
Type 11 - Acreage Record.pdf Supplementary Document	2019-06-25
Type 10 - Policy Producer.pdf Supplementary Document	2019-06-25
Type 09 - Fund Designation Record.pdf Supplementary Document	2019-06-25
Type 05 - CIMS Report Record.pdf Supplementary Document	2019-06-25

IC Document Collections

IC ID	Document Title	Status
36879	Private Sector - Farms Other-List of Types for Private Sector	Modified
185264	Companies, Agents & Loss Adjusters Other-List of Types for Agents, Companies & Loss Adjusters	Modified

ICR Details

OMB Control No:	ICR Reference No:
Status:	Previous ICR Reference No:
Agency/Subagency:	Agency Tracking No:
Title:
Type of Information Collection:	Common Form ICR:
Type of Review Request:	Date Received in OIRA:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract:

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR?

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Number of Information Collection (IC) in this ICR: 0

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ICR Summary of Burden

	Total	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	0	0	0	0	0	0
Annual Time Burden (Hours)	0	0	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion:

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion:

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods?

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.    

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.    

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?

Is this ICR related to the Pandemic Response?

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Common Form ICR: 

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date:

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