Information Collection

Certification of Compliance with Mandatory Bars to Employment

IC 31915 under ICR 201808-3064-002 · OMB 3064-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0121 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDIC-2120/16 Certification of Compliance with Mandatory Bars to Employment	Form
FDIC-2120/16 Applicant Certification Statement FORM 2120-16 Updated.pdf	Form

IC Title:

Certification of Compliance with Mandatory Bars to Employment

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	FDIC-2120/16	Applicant Certification Statement	FORM 2120-16 Updated.pdf		No		Paper Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: 30-64-0015 Personnel Records

FR Citation: 80 FR 66982

Number of Respondents: 500

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500	-100	600
Annual IC Time Burden (Hours)	83	-17	100
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.