7200/14 Declaration for Health and Welfare Plan

Forms Relating to Processing Deposit Insurance Claims

Documents and Forms

Document Name Document Type
Form 7200/14 7200/14 Declaration for Health and Welfare Plan Form and Instruction
7200/14 Declaration for Health and Welfare Plan f7200-14.pdf Form and Instruction
7200/14 Declaration for Health and Welfare Plan f7200-14.pdf Form and Instruction

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	7200/14	Declaration for Health and Welfare Plan	f7200-14.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: FDIC 30-64-0013	FR Citation: 87 FR 66178

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	Previously Approved
Annual Number of Responses for this IC	1	-11	12
Annual IC Time Burden (Hours)	1	-11	12
Annual IC Cost Burden (Dollars)	0	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.