7200/12 Declaration for defined Benefit 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⚠️ Notice: This information collection may be referencing outdated material.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 7200/12 7200/12 Declaration for defined Benefit Plan Form and Instruction
7200/12 Declaration for Defined Benefit Plan 7200-12 FINAL; Expiration 20200831.docx www.fdic.gov/resources/forms/deposit-claims-and-asset-sales/ Form and Instruction

Information Collection (IC) Details

IC Title:	7200/12 Declaration for defined Benefit Plan	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 12 CFR 330

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	7200/12	Declaration for Defined Benefit Plan	7200-12 FINAL; Expiration 20200831.docx	https://www.fdic.gov/resources/forms/deposit-claims-and-asset-sales/	Yes	Yes	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

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

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

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
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.