SUPPLEMENTAL STATEMENT IN SUPPORT OF AN APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT OR DESTRUCTION OF UNITED STATES SAVINGS AND RETIREMENT SECURITIES
ICR 198311-1535-002
OMB: 1535-0054
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1535-0054 can be found here:
SUPPLEMENTAL STATEMENT IN
SUPPORT OF AN APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT OR
DESTRUCTION OF UNITED STATES SAVINGS AND RETIREMENT SECURITIES
THE APPROVAL OF
THIS FORM THROUGH NOVEMBER 1986 IS CONDITIONAL. IT REQUIRES THAT
THE OMB NUMBER AND THE NATURE OF THE COLLECTION IN ACCORDANCE WITH
5 CFR 1320.12 (D) AND 1320.18 (B) BE DISPLAYED ON THE FORM BY MARCH
31, 1984. THE EXISTING SUPPLY OF FORMS MAY BE USED BY ATTACHING A
SHEET WITH THIS ADDITIONAL INFORMATION OR BY OTHER APPROPRIATE
MEANS. THE OMB DESK OFFICER IS TO BE INFORMED BY JANUARY 15, 1984
OF STEPS TAKEN TO COMPLY WITH THIS REQUIREMENT.
Inventory as of this Action
Requested
Previously Approved
11/30/1986
11/30/1986
01/31/1984
12,000
0
25,000
1,200
0
2,075
0
0
0
SUPPLEMENTAL STATEMENT BY BONDHOLDER
IN SUPPORT OF AN APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT,
OR DESTRUCTION OF UNITED STATES SAVINGS BONDS AND RETIREMENT
SECURITIES.
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:
(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;
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.