Forms Relating to Processing Deposit Insurance Claims

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 7200.04 Forms Relating to Processing Deposit Insurance Claims	Form and Instruction	Modified	Available
SPST-0143 Forms for Processing Deposit Insurance Claims 1-31-14 (rev. 5-8-14).docx	Supporting Statement A	Uploaded 2014-05-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
31961	Forms Relating to Processing Deposit Insurance Claims	Form and Instruction	Modified

ICR Details

OMB Control No: 3064-0143	ICR Reference No: 201401-3064-001
Status: Historical Active	Previous ICR Reference No: 201301-3064-007
Agency/Subagency: FDIC	Agency Tracking No:
Title: Forms Relating to Processing Deposit Insurance Claims
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/09/2014
	Date Received in OIRA: 01/31/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	36 Months From Approved	08/31/2016
Responses	1,311	0	395
Time Burden (Hours)	707	0	320
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:
	79 FR 62631	10/22/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 2170	01/11/2014
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	7200.26, 7200.15, 7200.18, 7200.24, 7200.04, 7200.05, 7200.08, 7200.06, 7200.07, 7200.9, 7200.11, 7200.10, 7200.12, 7200.13, 7200.14	Declaration for Public Unit Deposit ,   Declaration for Revocable Trust ,   Declaration of Independent Activity ,   Declaration of Independent Activity for Unincorporated Association ,   Declaration of Joint Ownership Deposit ,   Declaration for Testamentary 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 Irrevocable Trust ,   Claimant Verification ,   Depositor Interview Form

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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	1,311	395	0	916	0	0
Annual Time Burden (Hours)	707	320	0	387	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: FDIC has revised its depositor claim forms and added two additional forms to more efficiently process depositor claims.

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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: 01/31/2014

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