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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.