Order Form

Application for Conversion; Proxy Statement; Offering Circular; Order Form

Documents and Forms

Document Name Document Type
Form Form 1683 Order Form Form and Instruction
Form 1683 Order Form Form1680_Form1681_Form1682_Form1683_20150731_f.pdf www.federalreserve.gov/apps/reportforms/default.aspx Form and Instruction

Information Collection (IC) Details

IC Title:	Order Form	Agency IC Tracking Number:	Form 1683

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 1683	Order Form	Form1680_Form1681_Form1682_Form1683_20150731_f.pdf	http://www.federalreserve.gov/apps/reportforms/default.aspx	Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

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.