APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT, OR DESTRUCTION OF UNITED STATES SAVINGS AND RETIREMENT SECURITIES, SUPPLEMENTAL STATEMENT IN SUPPORT OF AN....
ICR 199401-1535-001
OMB: 1535-0013
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1535-0013 can be found here:
APPLICATION FOR RELIEF ON
ACCOUNT OF LOSS, THEFT, OR DESTRUCTION OF UNITED STATES SAVINGS AND
RETIREMENT SECURITIES, SUPPLEMENTAL STATEMENT IN SUPPORT OF
AN....
Extension without change of a currently approved collection
You may omit
printing the expiration date on this form.
Inventory as of this Action
Requested
Previously Approved
04/30/1997
04/30/1997
05/31/1994
80,000
0
80,000
32,000
0
32,000
0
0
0
APPLICATION USED BY OWNERS OF
SECURITIES TO REQUEST SUBSTITUTE OR PAYMENT IN LIEU OF LOST,
STOLEN, OR DESTROYED SECURITIES. SUPPLEMENTA STATEMENTS USED BY
OWNERS OR OTHERS HAVING KNOWLEDGE CONCERNING THE
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.