Information Collection

Interagency Notice of Change in Director or Executive Officer

IC 31859 under ICR 201203-3064-002 · OMB 3064-0097.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0097 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3064-0097 Interagency Notice of Change in Director or Senior Executive Officer Interagency Notice of Change in Director or Executive Officer	Form and Instruction
3064-0097 Interagency Notice of Change in Director or Senior Execu ESS 0097 Form 4-21-09.pdf www.fdic.gov/formsdocuments/interag1.pdf	Form and Instruction

IC Title:

Interagency Notice of Change in Director or Executive Officer

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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 and Instruction	3064-0097			http://www.fdic.gov/formsdocuments/interag1.pdf	Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 840

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	840	440	400
Annual IC Time Burden (Hours)	1,680	880	800
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.

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