Supplemental Evidence for Proof of Claim

Involuntary Liquidation Proof of Claim Form

⚠️ Notice: This information collection may be referencing outdated material.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
Supplementary Evidence Requirement §709.6.docx Other-Supplementary Evidence Require

Information Collection (IC) Details

IC Title:	Supplemental Evidence for Proof of Claim	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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Supplementary Evidence Requirements			Supplementary Evidence Requirement §709.6.docx		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	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	20	20
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	1,000	1,000

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.