Owner's Affidavit of Partial Destruction of Mutilated Currency

ICR 200510-1520-002

OMB: 1520-0001

Federal Form Document

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Document
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Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1520-0001 200510-1520-002
Historical Active 200209-1520-001
TREAS/BEP
Owner's Affidavit of Partial Destruction of Mutilated Currency
Extension without change of a currently approved collection   No
Regular
Approved without change 01/03/2006
Retrieve Notice of Action (NOA) 10/25/2005
  Inventory as of this Action Requested Previously Approved
01/31/2009 01/31/2009 01/31/2006
150 0 300
90 0 180
0 0 0

The Office of Currency Standards, Bur of Eng & Printing requests owners of partially destroyed U.S. currency to complete a notarized affidavit (BEP 5283) for each claim sumitted 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 BEP-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 150 300 0 0 -150 0
Annual Time Burden (Hours) 90 180 0 0 -90 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.
10/25/2005


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