REPORT/APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT OR DESTRUCTION OF UNITED STATES BEARER SECURITIES (INDIVIDUALS)

ICR 199407-1535-004

OMB: 1535-0016

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
1535-0016 199407-1535-004
Historical Active 199107-1535-010
TREAS/BPD
REPORT/APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT OR DESTRUCTION OF UNITED STATES BEARER SECURITIES (INDIVIDUALS)
Extension without change of a currently approved collection   No
Regular
Approved without change 09/27/1994
Retrieve Notice of Action (NOA) 07/06/1994
You may omit printing the expiration date on this form.
  Inventory as of this Action Requested Previously Approved
09/30/1997 09/30/1997 09/30/1994
100 0 100
92 0 92
0 0 0

THIS FORM IS REQUIRED BY THE BUREAU IN ORDER TO OBTAIN COMPENSATION FO LOST, STOLEN, OR DESTROYED BEARER SECURITIES. IT IS USUALLY EXECUTED BY PARTIES THAT PURCHASED, WERE GIVEN, OR ENTITLED TO BEARER SECURITIE AND THESE SECURITIES ARE NO LONGER IN THEIR POSSESSION.

None
None


No

1
IC Title Form No. Form Name
REPORT/APPLICATION FOR RELIEF ON ACCOUNT OF LOSS, THEFT OR DESTRUCTION OF UNITED STATES BEARER SECURITIES (INDIVIDUALS) PD F 1022-1

  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 100 100 0 0 0 0
Annual Time Burden (Hours) 92 92 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.
07/06/1994


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