4094.stm

SUPPORTING STATEMENT
Justification for:
PD F 4094, “ Affidavit By Individual Surety.”
1. Explain the circumstances that make the collection of
information necessary. Identify any legal or
administrative requirements that necessitate the
collection. A Bond of Indemnity may be required under
certain conditions deemed necessary for the protection
of the interest of the United States.
2. Indicate how, by whom, and for what purpose the
information is to be used. Used to support a Bond of
Indemnity executed in connection with a claim for
relief on account of lost, stolen or destroyed United
States securities. Without the information, the
transaction cannot be completed.

3. Describe whether, and to what extent, the collection
of information involves the use of automated,
electronic, mechanical, or other technological
collection techniques or other forms of information
technology. What consideration is given to use
information technology to reduce burden?
Public Debt has been a leader in e-Gov, providing the
public with options for conducting financial
transactions online for several years. To provide our
customers additional options for submitting information
electronically, we are taking the following steps: a
technical project team is exploring options (such as
pay.gov) and will select the
mechanism(s)/infrastructure needed; concurrently,
reengineering of business processes (and forms) is
being conducted as the result of a reorganization of
our major business lines.

4. Describe efforts to identify duplication. Why can’t
any similar information already available be used or
modified for use for the purposes described in item 2
above? Duplicate information is not requested.

5. If the collection of information impacts small
business or other small entities describe any methods
used to minimize burden? This collection of
information does not impact small business or other
small entities.
6. What consequences to Federal program or policy
activities and what, if any, technical or legal
obstacles to reducing burden will occur if this
collection is not conducted or is conducted less
frequently? N/A
7. Is this collection of information conducted in a
manner consistent with the guidelines of 5 CFR 1320.6?
The collection of information cannot be conducted less
frequently because the collection is initiated for a
single purpose.
8. What effort was made to notify the general public
about this collection of information? The Bureau’s
notice was published in the Federal Register on June
7, 2006, Page 33036. No comments were received.
9. What decision was made to provide any payment or gift
to respondents, other than reenumeration of
contractors or grantees? N/A
10. What assurance of confidentiality was provided to
respondents and what was the basis for the assurance in
statute, regulations, or agency policy? In accordance
with the Privacy Act of 1974, information furnished by
the public is assured confidentiality.
11. What justification is there for questions of a
sensitive nature? There are no questions of a sensitive
nature.
12. What is the estimated hour burden of this collection
of information? The average time needed is 55 minutes
per response multiplied by the estimated number of
responses (500) reflects the total burden of 460 hours.
13.

What is the estimated total annual cost burden to
respondents or recordkeepers resulting from this
collection of information? Estimated cost burden
to respondents is not available.

14.

What is the annualized cost to the Federal
Government? The following factors were used to
estimate the annual burden to this agency:
a. Printing cost - estimated number of forms
printed annually, multiplied by the unit cost
of the forms.
b. Case processing cost – estimated number of
forms completed, multiplied by a percentage of
the unit cost of case processing.
c. Forms management cost - salary cost of forms
management personnel.
Printing Cost
500 @ $20.00/M
Case Processing Cost 500
1.50/form
Forms Management Cost
Total Cost

= $
=
=
$

10.
750.
500.
1,260.

15.

What is the reason for any program changes or
adjustments reported in Items 13 or 14 of the OMB
Form 83-I? N/A

16.

For collections of information whose results will
be published, outline plans for tabulation and
publication. The results of the collection of this
information will not be published for statistical
use.

17.

If seeking approval to not display the expiration
date for OMB approval of this information
collection, what are the reasons that the display
would be inappropriate? N/A

18.

What are the exceptions to the certification
statement? N/A