Information Collection

Check Sample Survey 2016

IC 205090 under ICR 201907-7100-010 · OMB 7100-0351.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 7100-0351 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FR 3066c Check Sample Survey 2016	Form and Instruction
FR 3066c Check Sample Survey FR3066c_20121214_f.pdf	Form and Instruction

IC Title:

Check Sample Survey 2016

Agency IC Tracking Number:

FR 3066c

Is this a Common Form? No

IC Status: Removed

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	FR 3066c	Check Sample Survey	FR3066c_20121214_f.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-150	150
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
No associated records found

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