Information Collection

Chairman Speaking Engagement Request Form

IC 250732 under ICR 202003-3064-009 · OMB 3064-0198.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0198 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDIC 1440/05 Chairman Speaking Engagement Request Form Chairman Speaking Engagement Request Form	Form and Instruction
FDIC 1440/05 Chairman Speaking Engagement Request Form Justification Memo 0198 - FDIC Chairman Event Request Form FINAL.docx	Form and Instruction
Justification Memo 0198 - FDIC Chairman Event Request Form FINAL.docx Justification Memo Chairman Speaking Engagement Request Form	IC Document

IC Title:

Chairman Speaking Engagement Request Form

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	FDIC 1440/05				Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification Memo Chairman Speaking Engagement Request Form		12/08/2021

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

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