Information Collection

Applicant Background Questionnaire

IC 44179 under ICR 200907-3064-005 · OMB 3064-0138.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0138 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2100/14 Applicant Background Questionnaire	Form
2100/14 Applicant Background Questionnaire 3064-0138 form.doc	Form

IC Title:

Applicant Background Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	2100/14	Applicant Background Questionnaire	3064-0138 form.doc		No		Paper Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,000	20,000	10,000
Annual IC Time Burden (Hours)	1,500	1,000	500
Annual IC Cost Burden (Dollars)	0	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.