FRF Agreement Form

Assessment Account Designation and Indepenent Bank Receivable Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0245 can be found here:

Documents and Forms

Document Name Document Type
Form TD F 105.1 FRF Agreement Form Form
TD F 105.1 FRF Assessment Agreement FRF Preauthorized Payment Agreementrev5.4.pdf Form

Information Collection (IC) Details

IC Title:	FRF Agreement Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	TD F 105.1	FRF Assessment Agreement	FRF Preauthorized Payment Agreementrev5.4.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	600	600

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.