Self-Monitoring Questionnaire

Self-Monitoring Questionnaire for Insurance and Finance Projects

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3420-0019 can be found here:

Documents and Forms

Document Name Document Type
Form OPIC-162 Self-Monitoring Questionnaire Form
OPIC-162_NEW_GUIDELINES.docx Instruction
OPIC-162 Self-Monitoring Questionnaire OPIC-162_NEW.docx Form

Information Collection (IC) Details

IC Title:	Self-Monitoring Questionnaire	Agency IC Tracking Number:	OPIC-162

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OPIC-162	Self-Monitoring Questionnaire	OPIC-162_NEW.docx		Yes	Yes	Fillable Fileable Signable
Instruction			OPIC-162_NEW_GUIDELINES.docx		Yes	No	Printable Only

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 465	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: 98 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	465	0	465
Annual IC Time Burden (Hours)	2,186	326	1,860
Annual IC Cost Burden (Dollars)	163,913	24,413	139,500

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.