OWNER'S AFFIDAVIT PARTIAL DESTRUCTION OF MUTILATED CURRENCY

ICR 198107-1510-004

OMB: 1510-0017

Federal Form Document

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Document
Name
Status
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ICR Details
1510-0017 198107-1510-004
Historical Active 198104-1510-017
TREAS/FMS
OWNER'S AFFIDAVIT PARTIAL DESTRUCTION OF MUTILATED CURRENCY
Extension without change of a currently approved collection   No
Regular
Approved without change 08/07/1981
Retrieve Notice of Action (NOA) 07/09/1981
  Inventory as of this Action Requested Previously Approved
08/31/1984 08/31/1984 12/31/1981
1,080 0 1,080
540 0 540
0 0 0

CURRENCY OPERATIONS DIVISION REQUESTS OWNERS OF PARTIALLY DESTROYED CURRENCY TO COMPLETE AND HAVE NOTARIZED AFFIDAVIT FORM-5283 FOR EACH CLAIM SUBMITTED WHEN SUBSTANTIAL PORTIONS OF THE NOTES ARE MISSING.

None
None


No

1
IC Title Form No. Form Name
OWNER'S AFFIDAVIT PARTIAL DESTRUCTION OF MUTILATED CURRENCY TFS 5283

  Total Approved 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 1,080 1,080 0 0 0 0
Annual Time Burden (Hours) 540 540 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/09/1981


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