Information Collection

Deposit Insurance Inquiry

IC 227590 under ICR 201707-3064-002 · OMB 3064-0134.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0134 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDIC 6422/04 Deposit Insurance Inquiry	Form and Instruction
FDIC 6422/04 FDIC Deposit Insurance Form FDIC Deposit Insurance Form.docx	Form and Instruction
FDIC 6422/04 Formulario de Seguro de Deposito Deposit Insurance Sp.docx	Form and Instruction
Justification Memo 0134 - Nonsubstantive Revisions to Customer Assitance Forms.docx Justification Memo 3064-0134	IC Document

IC Title:

Deposit Insurance Inquiry

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	FDIC 6422/04	FDIC Deposit Insurance Form	FDIC Deposit Insurance Form.docx		Yes	Yes	Fillable Fileable
Form and Instruction	FDIC 6422/04	Formulario de Seguro de Deposito	Deposit Insurance Sp.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: 1,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification Memo 3064-0134	Justification Memo 0134 - Nonsubstantive Revisions to Customer Assitance Forms.docx	07/19/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.