APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT OR DESTRUCTION OF UNITED STATES REGISTERED SECURITIES

ICR 198504-1535-005

OMB: 1535-0014

Federal Form Document

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Name
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ICR Details
1535-0014 198504-1535-005
Historical Active 198208-1535-007
TREAS/BPD
APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT OR DESTRUCTION OF UNITED STATES REGISTERED SECURITIES
Extension without change of a currently approved collection   No
Regular
Approved without change 06/03/1985
Retrieve Notice of Action (NOA) 04/05/1985
Approved with the applicable changes described in Ms. Turner's undated memorandum, "Re-certification of Public Information Collection Requirements." Changes to be made to this form include: 1) removal of the question and instructions on marital status, and 2) addition of a Paperwork Reduction Act notice. In addition, a copy of the authorizing statute and rules should be submitted for the docket file to arrive no later than 6/30/85. During the first three months of the appoval period, until new forms can be printed, the exising forms may be used providing: 1) the expiration date is corrected and 2) the question on marital status and corresponding instructions are blocked out.
  Inventory as of this Action Requested Previously Approved
06/30/1988 06/30/1988 05/31/1985
325 0 325
300 0 300
0 0 0

THE FORM IS NEEDED AND REQUIRED BY THE BUREAU IN ORDER TO OBTAIN COMPENSATION. IT IS GNERALLY USED BY PARTIES THAT HAVE PURCHASED SECURITIES OR THE OWNER OF REGISTERED SECURITIES WHEN SUCH SECURITIES ARE NO LONGER IN THEIR POSSESSION LEGALLY.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT OR DESTRUCTION OF UNITED STATES REGISTERED SECURITIES PD 1025

  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 325 325 0 0 0 0
Annual Time Burden (Hours) 300 300 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.
04/05/1985


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