"OWNER'S AFFIDAVIT OF PARTIAL DESTRUCTION OF MUTILATED CURRENCY"

ICR 198404-1520-002

OMB: 1520-0001

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1520-0001 198404-1520-002
Historical Active
TREAS/BEP
"OWNER'S AFFIDAVIT OF PARTIAL DESTRUCTION OF MUTILATED CURRENCY"
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/30/1984
Retrieve Notice of Action (NOA) 04/17/1984
  Inventory as of this Action Requested Previously Approved
04/30/1987 04/30/1987
1,100 0 0
550 0 0
0 0 0

OFFICE OF CURRENCY REDEMPTION AND DESTRUCTION STANDARDS, BUREAU OF ENGRAVING AND PRINTING, REQUESTS OWNERS OF PARTIALLY DESTROYED U.S. CURRENCY TO COMPLETE NOTARIZED AFFIDAVIT (FORM TFS 5283) FOR EACH CLAI SUBMITTED WHEN SUBSTANTIAL PORTIONS OF NOTES ARE MISSING.

None
None


No

1
IC Title Form No. Form Name
"OWNER'S AFFIDAVIT OF 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 1,100 0 0 1,100 0 0
Annual Time Burden (Hours) 550 0 0 550 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
04/17/1984


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