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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.