Information Collection

Certified Statement for Seminannual Deposit Insurance Assessment

IC 31803 under ICR 201609-3064-006 · OMB 3064-0057.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0057 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6420-07 Certified Statement for Seminannual Deposit Insurance Assessment	Form and Instruction
6420-07 Quarterly Certified Statement Invoice 6420-07.pdf	Form and Instruction

IC Title:

Certified Statement for Seminannual Deposit Insurance Assessment

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 12 CFR 327

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	6420-07	Quarterly Certified Statement Invoice	6420-07.pdf		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: 6,081

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	24,324	-3,536	27,860
Annual IC Time Burden (Hours)	8,108	-1,179	9,287
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.