Information Collection

Affidavit By Individual Surety

IC 16619 under ICR 201511-1530-009 · OMB 1530-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1530-0047 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FS Form 4094 Affidavit By Individual Surety	Form and Instruction
FS Form 4094 Affidavit By Individual Surety sec4094.pdf www.treasurydirect.gov/forms/sec4094.pdf	Form and Instruction

IC Title:

Affidavit By Individual Surety

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 31 CFR 306

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 4094	Affidavit By Individual Surety	sec4094.pdf	http://www.treasurydirect.gov/forms/sec4094.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: 200

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	200	-300	500
Annual IC Time Burden (Hours)	183	-277	460
Annual IC Cost Burden (Dollars)	0	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.