Information Collection

Examination Questionnaire

IC 20077 under ICR 201010-1557-003 · OMB 1557-0199.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1557-0199 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Examination Questionnaire	Form
Examination Questionnaire Exam Questionnaire REV08.pdf	Form

IC Title:

Examination 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	N/A	Examination Questionnaire	Exam Questionnaire REV08.pdf		Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,565

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,393	-209	1,602
Annual IC Time Burden (Hours)	233	-34	267
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.