Deposit Insurance Inquiry

Customer Assistance Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0134 can be found here:

Documents and Forms

Document Name Document Type
Form FDIC 6422/04 Deposit Insurance Inquiry Form and Instruction
FDIC 6422/04 FDIC Deposit Insurance Form FDIC Deposit Insurance Form.docx Form and Instruction
FDIC 6422/04 Formulario de Seguro de Deposito Deposit Insurance Sp.docx Form and Instruction
Justification Memo 0134 - Nonsubstantive Revisions to Customer Assitance Forms.docx Justification Memo 3064-0134 IC Document

Information Collection (IC) Details

IC Title:	Deposit Insurance Inquiry	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDIC 6422/04	FDIC Deposit Insurance Form	FDIC Deposit Insurance Form.docx		Yes	Yes	Fillable Fileable
Form and Instruction	FDIC 6422/04	Formulario de Seguro de Deposito	Deposit Insurance Sp.docx		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification Memo 3064-0134	Justification Memo 0134 - Nonsubstantive Revisions to Customer Assitance Forms.docx	07/19/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.