Affidavit by Individual Surety

ICR 200908-1535-003

OMB: 1535-0100

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2009-08-07
IC Document Collections
IC ID
Document
Title
Status
16619 Modified
ICR Details
1535-0100 200908-1535-003
Historical Active 200608-1535-002
TREAS/BPD
Affidavit by Individual Surety
Extension without change of a currently approved collection   No
Regular
Approved without change 09/28/2009
Retrieve Notice of Action (NOA) 08/25/2009
  Inventory as of this Action Requested Previously Approved
09/30/2012 36 Months From Approved 10/31/2009
500 0 500
460 0 460
0 0 0

Affidavit from individual acting as surety for indemnification agreement for lost, stolen or destroyed securities.

None
None

Not associated with rulemaking

  74 FR 27063 06/05/2009
74 FR 41782 08/18/2009
No

1
IC Title Form No. Form Name
Affidavit By Individual Surety PD F 4094 Affidavit By Individual Surety

  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 500 500 0 0 0 0
Annual Time Burden (Hours) 460 460 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$1,260
No
No
Uncollected
Uncollected
No
Uncollected
Judi Owens 304 480-8150 [email protected]

  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.
08/25/2009


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