Affidavit by Individual Surety

ICR 201409-1530-011

OMB: 1530-0047

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Supporting Statement A
2012-07-27
IC Document Collections
IC ID
Document
Title
Status
16619 Unchanged
ICR Details
1530-0047 201409-1530-011
Historical Active 200908-1535-003
TREAS/FISCAL
Affidavit by Individual Surety
Extension without change of a currently approved collection   No
Regular
Approved without change 09/10/2014
Retrieve Notice of Action (NOA) 09/10/2014
  Inventory as of this Action Requested Previously Approved
11/30/2015 36 Months From Approved
500 0 500
460 0 460
0 0 0

The information is requested to support a request to serve as surety for an indemnification agreement on a Bond of Indemnity.

US Code: 31 USC 31 Name of Law: null
  
None

Not associated with rulemaking

  77 FR 32179 05/31/2012
77 FR 56709 09/13/2012
No

1
IC Title Form No. Form Name
Affidavit By Individual Surety PD F 4094 Affidavit By Individual Surety

  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 500 500 0 0 0 0
Annual Time Burden (Hours) 460 460 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$1,260
No
No
No
No
No
Uncollected
Bruce Sharp 304 480-8112 [email protected]

  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.
09/13/2012


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