Information Collection

Agreement for Services (expert or Legal Support Services Provider) Provider Rate Schedule

IC 238896 under ICR 201911-3064-005 · OMB 3064-0122.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0122 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5210/04 Agreement for Services (expert or Legal Support Services Provider) Provider Rate Schedule	Form
5210/04 Agreement for Services (expert or Legal Support Service 5210-04 Agreement for Services (Expert - Legal Support Services (LSS) Provider Rate Schedule.pdf	Form

IC Title:

Agreement for Services (expert or Legal Support Services Provider) Provider Rate Schedule

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 361 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	5210/04	Agreement for Services (expert or Legal Support Service Provider) Provider Rate Schedule	5210-04 Agreement for Services (Expert - Legal Support Services (LSS) Provider Rate Schedule.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: 100

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
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	100	100
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.