Assessment Account Designation and Indepenent Bank Receivable Form

Forms and Documents

Document Name	Status
Form TD F 105.1 FRF Agreement Form Form	Modified
Supporting_Statement_for_Assessments_Form_revised.doc Supporting Statement A	2012-07-27

IC Document Collections

IC ID	Document Title	Status
200585	FRF Agreement Form Form	Modified

ICR Details

OMB Control No: 1505-0245	ICR Reference No: 201209-1505-002
Status: Historical Active	Previous ICR Reference No: 201205-1505-003
Agency/Subagency: TREAS/DO	Agency Tracking No:
Title: Assessment Account Designation and Indepenent Bank Receivable Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/12/2012
	Date Received in OIRA: 09/12/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2015	36 Months From Approved
Responses	48	0	0
Time Burden (Hours)	24	0	0
Cost Burden (Dollars)	600	0	0

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Abstract: The Financial Research Fund (FRF) Preauthorized Payment Agreement Form will collect information with respect to the final rule on the assessment of fees on large bank holding companies and nonbank financial companies supervised by the FRB to cover the expenses of the FRF.

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Authorizing Statute(s): PL: Pub.L. 111 - 203 155 Name of Law: Wall Street Reform and Consumer Protection Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 203 155 Name of Law: Wall Street Reform and Consumer Protection Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1505-AC42	Final or interim final rulemaking	77 FR 29884	05/21/2012

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
FRF Agreement Form	TD F 105.1	FRF Assessment Agreement

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ICR Summary of Burden

	Total Approved	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	48	0	48	0	0	0
Annual Time Burden (Hours)	24	0	24	0	0	0
Annual Cost Burden (Dollars)	600	0	600	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

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

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 05/10/2012

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