Information Collection

Forms Relating to Processing Deposit Insurance Claims

IC 31961 under ICR 201401-3064-001 · OMB 3064-0143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0143 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 7200.04 Forms Relating to Processing Deposit Insurance Claims	Form and Instruction
7200.04 Declaration for Public Unit Deposit 7200-04.doc	Form and Instruction
7200.05 Declaration for Revocable Trust 7200-05.doc	Form and Instruction
7200.06 Declaration of Independent Activity 7200-06.doc	Form and Instruction
7200.07 Declaration of Independent Activity for Unincorporated A 7200-07.doc	Form and Instruction
7200.08 Declaration of Joint Ownership Deposit 7200-08.doc	Form and Instruction
7200.9 Declaration for Testamentary Deposit 7200-09.doc	Form and Instruction
7200.10 Declaration for Defined Contribution Plan 7200-10.doc	Form and Instruction
7200.11 Declaration for IRA/KEOGH Deposit 7200-11 (3).doc	Form and Instruction
7200.12 Declaration for Defined Benefit Plan 7200-12.docx	Form and Instruction
7200.13 Declaration of Custodian Deposit 7200-13.doc	Form and Instruction
7200.14 Declaration for Health and Welfare Plan 7200-14.doc	Form and Instruction
7200.15 Declaration for Plan and Trust 7200-15.doc	Form and Instruction
7200.18 Declaration for Irrevocable Trust 7200-18.doc	Form and Instruction
7200.24 Claimant Verification 7200-24.docx	Form and Instruction
7200.26 Depositor Interview Form 7200-26 (3).doc	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Forms Relating to Processing Deposit Insurance Claims

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	7200.04	Declaration for Public Unit Deposit	7200-04.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.05	Declaration for Revocable Trust	7200-05.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.06	Declaration of Independent Activity	7200-06.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.07	Declaration of Independent Activity for Unincorporated Association	7200-07.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.08	Declaration of Joint Ownership Deposit	7200-08.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.9	Declaration for Testamentary Deposit	7200-09.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.10	Declaration for Defined Contribution Plan	7200-10.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.11	Declaration for IRA/KEOGH Deposit	7200-11 (3).doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.12	Declaration for Defined Benefit Plan	7200-12.docx	Yes	Yes	Fillable Printable
Form and Instruction	7200.13	Declaration of Custodian Deposit	7200-13.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.14	Declaration for Health and Welfare Plan	7200-14.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.15	Declaration for Plan and Trust	7200-15.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.18	Declaration for Irrevocable Trust	7200-18.doc	Yes	Yes	Fillable Printable
Form and Instruction	7200.24	Claimant Verification	7200-24.docx	Yes	Yes	Fillable Printable
Form and Instruction	7200.26	Depositor Interview Form	7200-26 (3).doc	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,311

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 34 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,311	916	395
Annual IC Time Burden (Hours)	707	387	320
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.