Form 5000/26 Non-Litigation Budget Form

OMB Number: 3064-0122
Expiration Date: 01/31/2023

Federal Deposit Insurance Corporation

NON-LITIGATION BUDGET
PAPERWORK REDUCTION ACT NOTICE
Public reporting burden for this collection of information is estimated to average 0.5 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to the Paper Reduction Act Clearance Officer, Legal Division, Federal Deposit Insurance
Corporation, 550 17th Street, N.W., Washington, D.C. 20429; and to the Office of Management and Budget, Paperwork Reduction
Project (3064-0122), Washington, D.C. 20503. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number.
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FDIC 5000/26 (5-21)

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OMB Number: 3064-0122
Expiration Date: 01/31/2023

Federal Deposit Insurance Corporation

NON-LITIGATION BUDGET
INSTRUCTIONS: Please provide all information requested.
SECTION I - INSTITUTION INFORMATION
1. Matter Number

2. Matter Caption

3. Institution Number 4. Institution Name

5. Firm Name

6. Institution Type
Bank

Thrift

SECTION II - NON-LITIGATION BUDGET INFORMATION
Attorney's Fees:

Estimated Recovery Value:

Hourly Rate:

$

Fixed Fee:
TOA Fee:
Contingent Fee:

% of

Specify nature of Non-Litigation work to be performed.

Estimated Hours for Completion:

Fees

Expenses

Total

Estimated Completion Date:
SECTION III - LAW FIRM BUDGET ACKNOWLEDGMENT
I acknowledge that the budget information contained herein is correct to the best of my knowledge and written approval of the Legal
Division is required for any increase in the total budget amount.
Authorized Law Firm Delegate
Name

Title

Signature

Telephone

Fax

Date

SECTION IV - BUDGET AUTHORIZATION FOR OUTSIDE COUNSEL TO PROCEED
FDIC Attorney (Recommending approval of budget)
Name

Signature

Date Budget Approved

Signature

Date Budget Approved

Delegated Authority
Name

FDIC 5000/26 (5-21)

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