Certified Statement for Seminannual Deposit Insurance Assessment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0057 can be found here:

Documents and Forms

Document Name Document Type
Form 6420-07 Certified Statement for Seminannual Deposit Insurance Assessment Form and Instruction
6420-07 Quarterly Certified Statement Invoice 6420-07.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certified Statement for Seminannual Deposit Insurance Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 12 CFR 327

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	6420-07	Quarterly Certified Statement Invoice	6420-07.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,258	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	21,032	-3,292	24,324
Annual IC Time Burden (Hours)	7,011	-1,097	8,108
Annual IC Cost Burden (Dollars)	0	0	0

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.