Forms Relating to Processing Deposit Insurance Claims

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 7200/05 Declaration for Revocable Trust	Form	Modified	Available
Form 7200/09 Declaration for Testamentary Deposit	Form	Modified	Available
Form 7200-15 Declaration for Plan and Trust	Form	Modified	Available
Form 7200.14 Declaration for Health and Welfare Plan	Form	Modified	Available
Form 7200.13 Declaration of Custodian Deposit	Form	Modified	Available
Form 7200.12 Declaration for Defined Benefit Plan	Form	Modified	Available
Form 7200.11 Declaration for IRA/KEOGH Deposit	Form	Modified	Available
Form 7200-10 Declaration for Defined Contribution Plan	Form	Modified	Available
Form 7200-08 Declaration of Joint Ownership Deposit	Form	Modified	Available
Form 7200/07 Declaration of Independent Activity for Unincorporated Association	Form	Modified	Available
Form 7200/06 Declaration of Independent Activity	Form	Modified	Available
Form 7200/04 Declaration for Public Unit Deposit	Form	Modified	Available
Supporting Statement OMB No 3064-1043 Renewal 2013.docx	Supporting Statement A	Uploaded 2013-05-13	Available
2013-11205.pdf	Supplementary Document	Uploaded 2013-05-13	Available
2013-02693.pdf	Supplementary Document	Uploaded 2013-02-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration for Revocable Trust
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration for Testamentary Deposit
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration for Plan and Trust
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration for Health and Welfare Plan
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration of Custodian Deposit
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration for Defined Benefit Plan
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration for IRA/KEOGH Deposit
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration for Defined Contribution Plan
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration of Joint Ownership Deposit
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration of Independent Activity for Unincorporated Association
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration of Independent Activity
31961	Forms Relating to Processing Deposit Insurance Claims	Form	Modified	Declaration for Public Unit Deposit

ICR Details

OMB Control No: 3064-0143	ICR Reference No: 201301-3064-007
Status: Historical Active	Previous ICR Reference No: 200911-3064-003
Agency/Subagency: FDIC	Agency Tracking No:
Title: Forms Relating to Processing Deposit Insurance Claims
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/02/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/13/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved	08/31/2013
Responses	395	0	5,095
Time Burden (Hours)	320	0	2,875
Cost Burden (Dollars)	0	0	0

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Abstract: Depositors and deposit brokers with funds in failed institutions may be required to provide information about different "ownerships rights and capacities" and the amount of funds held in the institution. This information assists the FDIC in making determinations regarding deposit insurance coverage.

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Authorizing Statute(s): US Code: 12 USC 1821(a) and (f) Name of Law: Federal Deposit Insurance Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 9049	02/07/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 27965	05/13/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Forms Relating to Processing Deposit Insurance Claims	7200-08, 7200.12, 7200.14, 7200-15, 7200/04, 7200/06, 7200/07, 7200.13, 7200.11, 7200-10, 7200/09, 7200/05	Declaration for Public Unit Deposit ,   Declaration of Independent Activity ,   Declaration of Independent Activity for Unincorporated Association ,   Declaration of Joint Ownership Deposit ,   Declaration for Defined Contribution Plan ,   Declaration for IRA/KEOGH Deposit ,   Declaration for Defined Benefit Plan ,   Declaration of Custodian Deposit ,   Declaration for Health and Welfare Plan ,   Declaration for Plan and Trust ,   Declaration for Testamentary Deposit ,   Declaration for Revocable Trust

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ICR Summary of Burden

table that charts list of burden

	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	395	5,095	0	0	-4,700	0
Annual Time Burden (Hours)	320	2,875	0	0	-2,555	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden reduction of 2,555 hours is the result in an adjustment of -4,700 in the number of claimants.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/13/2013

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