Information Collection

Owner's Affidavit of Partial Destruction of Mutilated Currency

IC 16457 under ICR 200901-1520-001 · OMB 1520-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1520-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BEP-5283 Owner's Affidavit of Partial Destruction of Mutilated Currency	Form
BEP-5283 Owner's Affadavit of Partial Destruction of Mutilated Cu BEP-5283.pdf	Form

IC Title:

Owner's Affidavit of Partial Destruction of Mutilated Currency

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	BEP-5283	Owner's Affadavit of Partial Destruction of Mutilated Currency	BEP-5283.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.