Information Collection

Integrity and Fitness Representations (Form 1600/12)

IC 185892 under ICR 201811-3064-006 · OMB 3064-0072.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0072 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3700/12 Integrity and Fitness Representations (Form 1600/12)	Form and Instruction
3700/12 Integrity and Fitness Representations and Certifications 3700-12; 20181220.doc www.fdic.gov	Form and Instruction

IC Title:

Integrity and Fitness Representations (Form 1600/12)

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 366

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	3700/12	Integrity and Fitness Representations and Certifications	3700-12; 20181220.doc	https://www.fdic.gov	Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: FDIC 30â64â0012 Financial Information Management Records

FR Citation: 80 FR 66981

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	12	-348	360
Annual IC Time Burden (Hours)	4	-115	119
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.