7200/14 – Declaration or Health and Welfare Plan

Forms Relating to Processing Deposit Insurance Claims

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0143 can be found here:

Documents and Forms

Document Name Document Type
Form 7200/14 7200/14 – Declaration or Health and Welfare Plan Form and Instruction
7200/14 Declaration or Health and Welfare Plan 7200-14.doc www.fdic.gov/regulations/laws/forms/claims.html Form and Instruction

Information Collection (IC) Details

IC Title:	7200/14 – Declaration or Health and Welfare Plan	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation: 12 CFR Part 330 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	7200/14	Declaration or Health and Welfare Plan	7200-14.doc	https://www.fdic.gov/regulations/laws/forms/claims.html	Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: FDIC-30--64--0013 - Insured Financial Institution Liquidation Records	FR Citation: 80 FR 66981

Number of Respondents: 12	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-12	12
Annual IC Time Burden (Hours)	-12	12
Annual IC Cost Burden (Dollars)	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.