Customer Assistance Forms

Forms and Documents

Document Name	Status
Form 6422/04 Customer Assistance Form and Instruction	Modified
Form 6422/15 Deposit Insurance Inquiry Form and Instruction	Modified
Form 6422/11 Business Assistance Form Form and Instruction	Modified
FR2-0134 Customer Assistance Forms 86 FR 67707 Nov 22 2021.pdf Supplementary Document	2021-11-28
FR1-0134 Consumer Assistance Forms 86 FR 52680 Sept 22 2021.pdf Supplementary Document	2021-11-28
3064-0028 SPST FINAL (2021) (WP).docx Supporting Statement A	2021-11-28

IC Document Collections

IC ID	Document Title	Status
31943	Customer Assistance Form and Instruction	Modified
227590	Deposit Insurance Inquiry Form and Instruction	Modified
202928	Business Assistance Form Form and Instruction	Modified

ICR Details

OMB Control No: 3064-0134	ICR Reference No: 202109-3064-007
Status: Received in OIRA	Previous ICR Reference No: 201809-3064-005
Agency/Subagency: FDIC	Agency Tracking No: 3064-0134
Title: Customer Assistance Forms
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/29/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2021
Responses	5,873	8,200
Time Burden (Hours)	1,468	2,050
Cost Burden (Dollars)	0	0

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Abstract: This collection facilitates the collection of information from customers of financial institutions that have inquiries or complaints about service. Customers or businesses may document their complaints or inquiries to the FDIC using a letter or optional forms (Form 6422/04; Form 6422/11; Form 6422/15). The Forms are used to facilitate online completion and submission of the complaints or inquiries and to shorten FDIC response times by making it easier to identify the nature of the complaint and to route the customer or business inquiry to the appropriate FDIC contact.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 52680	09/22/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 67707	11/29/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Business Assistance Form	6422/11, 6422/11	Business Assistance Form ,   Business Assistance Form (Spanish)
Customer Assistance	6422/04, 6422/04	Customer Assistance Form ,   Customer Assistance Form (Spanish)
Deposit Insurance Inquiry	6422/15, 6422/15	Deposit Insurance Form ,   Deposit Insurance Form (Spanish)

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ICR Summary of Burden

	Total Request	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	5,873	8,200	0	0	-2,327	0
Annual Time Burden (Hours)	1,468	2,050	0	0	-582	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/29/2021

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