Information Collection

Affidavit By Individual Surety

IC 16619 under ICR 200908-1535-003 · OMB 1535-0100.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1535-0100 can be found here:

Documents and Forms

Document Name Document Type
Form PD F 4094 Affidavit By Individual Surety Form and Instruction
PD F 4094 Affidavit By Individual Surety PDF4094.pdf www.treasurydirect.gov/forms/sec4094.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Affidavit By Individual Surety	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 31 CFR 306

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PD F 4094	Affidavit By Individual Surety	PDF4094.pdf	http://www.treasurydirect.gov/forms/sec4094.pdf	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	460	460
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.