Owner's Affidavit of Partial Destruction of Mutilated Currency

ICR 201203-1520-001

OMB: 1520-0001

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2012-03-26
IC Document Collections
ICR Details
1520-0001 201203-1520-001
Historical Active 200901-1520-001
TREAS/BEP
Owner's Affidavit of Partial Destruction of Mutilated Currency
Extension without change of a currently approved collection   No
Regular
Approved without change 05/28/2012
Retrieve Notice of Action (NOA) 03/29/2012
  Inventory as of this Action Requested Previously Approved
05/31/2015 36 Months From Approved 05/31/2012
150 0 150
90 0 90
0 0 0

The Office of Currency Standards, Bureau of Engraving & Printing, requests owners of partially destroyed U.S. currency to complete a notarized affidavit (BEP 5283) for each claim submitted when substantial portions of notes are missing.

US Code: 31 USC 5118-5120 Name of Law: null
  
None

Not associated with rulemaking

  77 FR 4083 01/26/2012
77 FR 19056 03/29/2012
No

1
IC Title Form No. Form Name
Owner's Affidavit of Partial Destruction of Mutilated Currency BEP 5283 Owner's Affidavit of Partial Destruction of Mutilated Currency

  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 150 150 0 0 0 0
Annual Time Burden (Hours) 90 90 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
No
No
No
Uncollected
Kevin Rice 202 874-5363

  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.
03/29/2012


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