Forms Relating to Processing Deposit Insurance Claims

ICR 202005-3064-002

OMB: 3064-0143

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Removed
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
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New
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New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
Removed
Form and Instruction
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Form and Instruction
Removed
Supporting Statement A
2020-08-13
Supplementary Document
2020-08-07
Supplementary Document
2020-08-03
IC Document Collections
IC ID
Document
Title
Status
31961 Removed
243112 New
243110 New
243106 New
243103 New
243102 New
243101 New
243100 New
243099 New
243096 New
243095 New
243093 New
243092 New
243091 New
243090 New
243089 New
226666
Unchanged
226665
Unchanged
226664
Unchanged
226663
Unchanged
226662 Removed
226661 Removed
226658 Removed
226653 Removed
226649 Removed
ICR Details
3064-0143 202005-3064-002
Active 201705-3064-001
FDIC
Forms Relating to Processing Deposit Insurance Claims
Extension without change of a currently approved collection   No
Regular
Approved without change 09/29/2020
Retrieve Notice of Action (NOA) 08/13/2020
  Inventory as of this Action Requested Previously Approved
09/30/2023 36 Months From Approved 09/30/2020
1,045 0 1,036
590 0 581
0 0 0

Depositors and deposit brokers with funds in failed institutions may be required to provide information about different "ownerships rights and capacities" and the amount of funds held in the institution. This information assists the FDIC in making determinations regarding deposit insurance coverage. The collection involves forms used by the FDIC to obtain information from depositors and deposit brokers necessary to supplement the records of failed insured depository institutions to make determinations regarding deposit insurance coverage. The information provided enables the FDIC to identify the actual owners of an account, each owner’s interest in the account, and the right and capacity in which the deposit is insured.

US Code: 12 USC 1821(a) and (f) Name of Law: Federal Deposit Insurance Act
  
None

Not associated with rulemaking

  85 FR 33667 06/02/2020
85 FR 47967 08/07/2020
No

19
IC Title Form No. Form Name
7200/24 Claimant Verification 7200/24 Claimant Verification
7200/12 Declaration for defined Benefit Plan 7200/12 Declaration for Defined Benefit Plan
7200/04 – Declaration for Government Deposit 7200-04 Declaration for Government Deposit
Diskette, following "Broker Input File Requirements"
Deposit Broker Submission Checklist
Diskette, following "Broker Input File Requirements"
Exhibit B, the standard agency agreement, or the non-standard agency agreement
7200/04 Declaration for Government Deposit 7200/04 Declaration for Government Deposit
7200/05 Declaration for Trust 7200/05 Declaration for Trust
7200/06 Declaration of Independent Activity 7200/06 Declaration of Independent Activity
7200/07 Declaration of Independent Activity for Unincorporated Association 7200/07 Declaration of Independent Activity for Unincorporated Association
7200/08 Declaration for Joint Ownership Report 7200/08 Declaration for Joint Ownership Deposit
7200/09 Declaration for Testamentary Deposit (In Trust For or Payable on Death) 7200/09 Declaration for Testamentary Deposit (In Trust For or Payable on Death)
7200/10 Declaration for Defined Contribution Plan 7200/10 Declaration for Defined Contribution Plan
7200/11 Declaration for IRA/KEOGH Deposit 7200/11 Declaration for IRA/KEOGH Deposit
7200/13 Declaration for Custodian Deposit 7200/13 Declaration for Custodian Deposit
7200/14 Declaration for Health and Welfare Plan 7200/14 Declaration for Health and Welfare Plan
7200/15 Declaration for Plan and Trust 7200/15 Declaration for Plan and Trust
7200/18 Declaration for Irrevocable Trust 7200/18 Declaration for Irrevocable Trust
7200/26 Depositor Interview 7200/26 Depositor Interview
7200/05 – Declaration for Revocable Trust 7200/05 Declaration for Revocable Trust
7200/09 – Declaration for Testamentary Deposit 7200/09 Declaration for Testamentary Deposit
7200/14 – Declaration or Health and Welfare Plan 7200/14 Declaration or Health and Welfare Plan
7200/24 – Claimant Verification 7200/24 Claimant Verification
7200/26 – Depositor Interview Form 7200/26 Depositor Interview Form

  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 1,045 1,036 0 90 -81 0
Annual Time Burden (Hours) 590 581 0 0 9 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
    Yes
    Yes
No
No
No
No
Manuel Cabeza 202 898-3781 mcabeza@fdic.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/13/2020


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