CERTIFICATE TO SUPPORT APPLICATION FOR RELIEF ON ACCOUNT OF LOST, STOLEN OR DESTROYED UNITED STATES SECURITIES

ICR 199111-1535-002

OMB: 1535-0108

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
1535-0108 199111-1535-002
Historical Active
TREAS/BPD
CERTIFICATE TO SUPPORT APPLICATION FOR RELIEF ON ACCOUNT OF LOST, STOLEN OR DESTROYED UNITED STATES SECURITIES
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/31/1992
Retrieve Notice of Action (NOA) 11/01/1991
  Inventory as of this Action Requested Previously Approved
01/31/1995 01/31/1995
400 0 0
200 0 0
0 0 0

THE FORM IS EXECUTED BY INDIVIDUALS TO SUPPORT AN APPLICATION FOR RELIEF ON ACCOUNT OF LOST, STOLEN OR DESTROYED UNITED STATES SECURITIES. THE PERSON EXECUTING THE FORM MUST PROVIDE A STATEMENT THAT FURNISHES ALL OF THE FACTS, TO THE BEST OF THEIR KNOWLEDGE, PERTAINING TO THE LOST, STOLEN OR DESTROYED SECURITIES.

None
None


No

1
IC Title Form No. Form Name
CERTIFICATE TO SUPPORT APPLICATION FOR RELIEF ON ACCOUNT OF LOST, STOLEN OR DESTROYED UNITED STATES SECURITIES

  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 400 0 0 400 0 0
Annual Time Burden (Hours) 200 0 0 200 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.
11/01/1991


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