Customer Assistance Forms

Forms and Documents

Document Name	Status
Form FDIC 6422/04 Deposit Insurance Inquiry Form and Instruction	New
Justification Memo 0134 - Nonsubstantive Revisions to Customer Assitance Forms.docx Justification for No Material/Nonsubstantive Change	2017-07-19
SPST-0134 2015 Renewal.doc Supporting Statement A	2015-06-24

IC Document Collections

IC ID	Document Title	Status
31943	Customer Assistance	Modified
227590	Deposit Insurance Inquiry Form and Instruction	New
202928	Business Assistance Form	Modified

ICR Details

OMB Control No: 3064-0134	ICR Reference No: 201707-3064-002
Status: Historical Active	Previous ICR Reference No: 201506-3064-002
Agency/Subagency: FDIC	Agency Tracking No:
Title: Customer Assistance Forms
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/19/2017
	Date Received in OIRA: 07/19/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2018	09/30/2018	09/30/2018
Responses	15,000	0	15,000
Time Burden (Hours)	3,751	0	7,500
Cost Burden (Dollars)	0	0	0

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Abstract: This collection permits the FDIC to collect information from customers of financial institutions who have inquiries or complaints about service. Customers may document their complaints or inquiries to the FDIC using a letter or online forms..

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 19318	04/10/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 34639	06/17/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Deposit Insurance Inquiry	FDIC 6422/04, FDIC 6422/04	FDIC Deposit Insurance Form ,   Formulario de Seguro de Deposito
Customer Assistance	FDIC 6422/04, FDIC 6422/04
Business Assistance Form	FDIC 6422/11, FDIC 6422/11

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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	15,000	15,000	0	0	0	0
Annual Time Burden (Hours)	3,751	7,500	0	0	-3,749	0
Annual Cost Burden (Dollars)	0	0	0	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:

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Annual Cost to Federal Government: $0

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]? No

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: 07/19/2017

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