Affidavit by Individual Surety

ICR 201904-1530-008

OMB: 1530-0047

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2019-12-03
IC Document Collections
IC ID
Document
Title
Status
16619 Modified
ICR Details
1530-0047 201904-1530-008
Active 201511-1530-009
TREAS/FISCAL
Affidavit by Individual Surety
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 07/10/2020
Retrieve Notice of Action (NOA) 12/03/2019
  Inventory as of this Action Requested Previously Approved
07/31/2023 36 Months From Approved
10 0 0
9 0 0
0 0 0

The information is requested to support a request to serve as surety for an indemnification agreement on a Bond of Indemnity.

US Code: 31 USC 31 Name of Law: null
  
None

Not associated with rulemaking

  84 FR 1832 02/05/2019
84 FR 60473 11/08/2019
No

1
IC Title Form No. Form Name
Affidavit By Individual Surety FS Form 4094 Affidavit By Individual Surety

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 10 0 0 -190 0 200
Annual Time Burden (Hours) 9 0 0 -174 0 183
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The form is used in processes related to securities that are no longer issued in paper form. The reduction of 174 burden hours is a program change due to agency discretion for a total of 9 hours requested.

$515
No
    Yes
    Yes
No
No
No
No
Bruce Sharp 304 480-8112 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/03/2019


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