Information Collection

Proof of Claim Form

IC 214533 under ICR 201501-3133-001 · OMB 3133-0192.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0192 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NCUA: 7250 Proof of Claim Form	Form and Instruction
NCUA: 7250 Proof Of Claim Proof of Claim Form with Privacy Act and PRA_FINALV2(3).docx	Form and Instruction

IC Title:

Proof of Claim Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 12 CFR 709.6 12 CFR 709.4(b)

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	NCUA: 7250	Proof Of Claim	Proof of Claim Form with Privacy Act and PRA_FINALV2(3).docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	10,000	10,000

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.