Information Collection

Report/Appl. for relief of loss, theft, destruction of U.S. Bearer Securities

IC 43846 under ICR 201511-1530-005 · OMB 1530-0033.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1530-0033 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FS Form 1022-1 Report/Appl. for relief of loss, theft, destruction of U.S. Bearer Securities	Form and Instruction
FS Form 1022-1 Report/Application for Relief on Account of Loss, Theft sec1022-1.pdf www.treasurydirect.gov/forms/sec1022-1.pdf	Form and Instruction

IC Title:

Report/Appl. for relief of loss, theft, destruction of U.S. Bearer Securities

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FS Form 1022-1	Report/Application for Relief on Account of Loss, Theft or Destruction of U.S. Bearer Securities (Individuals)	sec1022-1.pdf	http://www.treasurydirect.gov/forms/sec1022-1.pdf	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	92	92
Annual IC Cost Burden (Dollars)	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.