AFFIDAVIT BY INDIVIDUAL SURETY

ICR 199108-1535-008

OMB: 1535-0100

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
127776 Migrated
ICR Details
1535-0100 199108-1535-008
Historical Active
TREAS/BPD
AFFIDAVIT BY INDIVIDUAL SURETY
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 11/25/1991
Retrieve Notice of Action (NOA) 08/06/1991
This is an existing collection requirement which has been in violation of the Paperwork Reduction Act. The Department and agency are reminde of the effect of the public protection clause of the Act, under which no person shall be subject to any penalty for failure to comply with any collection of information that does not display a valid OMB contro number (5 CFR 1320.5(a).
  Inventory as of this Action Requested Previously Approved
11/30/1994 11/30/1994
500 0 0
460 0 0
0 0 0

THE FORM SERVES AS AN AFFIDAVIT FROM INDIVIDUALS WHO AGREE TO ACT AS SURETY FOR AN INDEMNIFICATION AGREEMENT ON A BOND OF INDEMNITY SUBMITT IN CONNECTION WITH A CLAIM FOR RELIEF DUE TO LOST, STOLEN, OR DESTROYED U.S. REGISTERED SECURITIES. THE INDIVIDUAL MUST STATE THEIR ASSETS AND LIABILITIES TO CERTIFY THEY ARE ELIGIBLE TO ACT AS SURETY.

None
None


No

1
IC Title Form No. Form Name
AFFIDAVIT BY INDIVIDUAL SURETY PD F 4094

  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 500 0 0 500 0 0
Annual Time Burden (Hours) 460 0 0 460 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.
08/06/1991


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