Forms Relating to FDIC Outside Counsel, Legal Support and Expert Services Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 5000/26 Non-Litigation Budget Form	Form	Modified	Repair queued
Form 5000/26 Non-Litigation Budget Form	Form	Modified	Repair queued
Form 5210/13 Legal Services Agreement	Form	Modified	Available
Form 5210/13 Legal Service Agreement (LSA)	Form	Modified	Repair queued
Form 5210/15 Legal Support Services (LSS) Provider Budget Form	Form	Modified	Available
Form 5210/15 Legal Support Services (LSS) Provider Budget Form	Form	Modified	Repair queued
Form 5210/14 Oral Representations for Certifications for Expert Legal Support Services	Form	Modified	Available
Form 5210/14 Oral Representations and Certifications for Expert Legal Support Services	Form	Modified	Repair queued
Form 5210/12 Firm Travel Voucher	Form	Modified	Available
Form 5210/12 Firm Travel Voucher	Form	Modified	Repair queued
Form 5210/11 Legal Invoice for Fees and Expenses	Form	Modified	Available
Form 5210/11 Legal Invoice for Fees and Expenses	Form	Modified	Repair queued
Form 5210/10 Outside Counsel Legal Services Agreement Rate Schedule	Form	Modified	Available
Form 5210/10 Outside Counsel Legal Services Agreement Rate Schedule	Form	Modified	Repair queued
Form 5210/09 Reps and Certs for Experts and Legal Support Services Providers	Form	Modified	Available
Form 5210/09 Reps and Certs for Experts and Legal Support Services Providers	Form	Modified	Repair queued
Form 5210/08 Expert Budget	Form	Modified	Repair queued
Form 5210/08 Expert budget	Form	Modified	Repair queued
Form 5210/06 Legal Services Agreement (LSA) Amendment	Form	Modified	Repair queued
Form 5210/06 Legal Services Agreement (LSA) Amendment	Form	Modified	Repair queued
Form 5210/04 Agreement for Services (expert or Legal Support Service Provider) Provider Rate Schedule	Form	Modified	Available
Form 5210/04 Agreement for Services (expert or Legal Support Services Provider) Provider Rate Schedule	Form	Modified	Repair queued
Form 5210/03 Agreement for Services (Expert Legal Support Services(LSS)) Provider Agreement	Form	Modified	Available
Form 5210/03 Agreement for Services (Expert Legal Support Services (LSS) Provider Amendment	Form	Modified	Repair queued
Form 5210/02 Legal Support Services (LSS) Provider Invoice for Fees and Expenses	Form	Modified	Available
Form 5210/02 Legal Support Services (LSS) Provider Invoice for Fees and Expenses (IF&E)	Form	Modified	Repair queued
Form 5210/01 Expert invoice for Fees and Expenses (EIF&E)	Form	Modified	Repair queued
Form 5210/01 Expert invoice for Fees and Expenses (EIF&E)	Form	Modified	Repair queued
Form 5200/01 Representations and Certifications for Legal Contractors	Form	Modified	Available
Form 5200/01 Representations and Certifications for Legal Contractors	Form	Modified	Repair queued
Form 5000/35 Litigation Budget	Form	Modified	Available
Form 5000/35 Litigation Budget	Form	Modified	Repair queued
Form 5000/33 Amended Non-Litigation Budget	Form	Modified	Repair queued
Form 5000/33 Amended Non-Litigation Budget	Form	Modified	Repair queued
Form 5000/31 Amended Litigation Budget	Form	Modified	Repair queued
Form 5000/31 Amended Litigation Budget	Form	Modified	Repair queued
3064-0122 Justification for Non-Substantive Forms Revision Legal Services.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-07-08	Repair queued
SPST-0122 Forms Relating to FDIC Outside Counsel Program 2019 Renewal - Ver 2.docx	Supporting Statement A	Uploaded 2020-01-23	Repair queued
FR2 - 0122 84 FR 68446 (16 DEC 2019).pdf	Supplementary Document	Uploaded 2019-12-16	Repair queued
FR1 - 0122 Forms Relating to FDIC Outside Counsel, Legal Support, and Expert Services Programs 84 FR 51566 (30 Sept 2019).pdf	Supplementary Document	Uploaded 2019-12-12	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
42567	Non-Litigation Budget Form	Form	Modified	Non-Litigation Budget Form
42567	Non-Litigation Budget Form	Form	Modified
238949	Legal Service Agreement (LSA)	Form	Modified	Legal Services Agreement
238949	Legal Service Agreement (LSA)	Form	Modified
238907	Legal Support Services (LSS) Provider Budget Form	Form	Modified	Legal Support Services (LSS) Provider Budget Form
238907	Legal Support Services (LSS) Provider Budget Form	Form	Modified
238904	Oral Representations and Certifications for Expert Legal Support Services	Form	Modified	Oral Representations for Certifications for Expert Legal Support Services
238904	Oral Representations and Certifications for Expert Legal Support Services	Form	Modified
238903	Firm Travel Voucher	Form	Modified	Firm Travel Voucher
238903	Firm Travel Voucher	Form	Modified
238902	Legal Invoice for Fees and Expenses	Form	Modified	Legal Invoice for Fees and Expenses
238902	Legal Invoice for Fees and Expenses	Form	Modified
238900	Outside Counsel Legal Services Agreement Rate Schedule	Form	Modified	Outside Counsel Legal Services Agreement Rate Schedule
238900	Outside Counsel Legal Services Agreement Rate Schedule	Form	Modified
238899	Reps and Certs for Experts and Legal Support Services Providers	Form	Modified	Reps and Certs for Experts and Legal Support Services Providers
238899	Reps and Certs for Experts and Legal Support Services Providers	Form	Modified
238898	Expert budget	Form	Modified	Expert Budget
238898	Expert budget	Form	Modified
238897	Legal Services Agreement (LSA) Amendment	Form	Modified	Legal Services Agreement (LSA) Amendment
238897	Legal Services Agreement (LSA) Amendment	Form	Modified
238896	Agreement for Services (expert or Legal Support Services Provider) Provider Rate Schedule	Form	Modified	Agreement for Services (expert or Legal Support Service Provider) Provider Rate Schedule
238896	Agreement for Services (expert or Legal Support Services Provider) Provider Rate Schedule	Form	Modified
238895	Agreement for Services (Expert Legal Support Services (LSS) Provider Amendment	Form	Modified	Agreement for Services (Expert Legal Support Services(LSS)) Provider Agreement
238895	Agreement for Services (Expert Legal Support Services (LSS) Provider Amendment	Form	Modified
238894	Legal Support Services (LSS) Provider Invoice for Fees and Expenses (IF&E)	Form	Modified	Legal Support Services (LSS) Provider Invoice for Fees and Expenses
238894	Legal Support Services (LSS) Provider Invoice for Fees and Expenses (IF&E)	Form	Modified
238893	Expert invoice for Fees and Expenses (EIF&E)	Form	Modified	Expert invoice for Fees and Expenses (EIF&E)
238893	Expert invoice for Fees and Expenses (EIF&E)	Form	Modified
238722	Representations and Certifications for Legal Contractors	Form	Modified	Representations and Certifications for Legal Contractors
238722	Representations and Certifications for Legal Contractors	Form	Modified
238721	Litigation Budget	Form	Modified	Litigation Budget
238721	Litigation Budget	Form	Modified
238720	Amended Non-Litigation Budget	Form	Modified	Amended Non-Litigation Budget
238720	Amended Non-Litigation Budget	Form	Modified
238719	Amended Litigation Budget	Form	Modified	Amended Litigation Budget
238719	Amended Litigation Budget	Form	Modified

ICR Details

OMB Control No: 3064-0122	ICR Reference No: 202107-3064-002
Status: Historical Active	Previous ICR Reference No: 201911-3064-005
Agency/Subagency: FDIC	Agency Tracking No: 3064-0122
Title: Forms Relating to FDIC Outside Counsel, Legal Support and Expert Services Programs
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/30/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/08/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2023	01/31/2023	01/31/2023
Responses	1,305	0	1,305
Time Burden (Hours)	907	0	907
Cost Burden (Dollars)	0	0	0

---

Abstract: The collection involves the submission of information on various forms by contractors who wish to do business with, or are currently under contract with the FDIC's Legal Division.

---

Authorizing Statute(s): US Code: 12 USC 1822(f)(3-4) Name of Law: FDI Act
   US Code: 12 USC 1819(a) Name of Law: FDI Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 51566	09/30/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 68446	12/16/2019
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 18

table that charts list of burden

IC Title	Form No.	Form Name
Agreement for Services (Expert Legal Support Services (LSS) Provider Amendment	5210/03	Agreement for Services (Expert Legal Support Services(LSS)) Provider Agreement
Agreement for Services (expert or Legal Support Services Provider) Provider Rate Schedule	5210/04	Agreement for Services (expert or Legal Support Service Provider) Provider Rate Schedule
Amended Litigation Budget	5000/31	Amended Litigation Budget
Amended Non-Litigation Budget	5000/33	Amended Non-Litigation Budget
Expert budget	5210/08	Expert Budget
Expert invoice for Fees and Expenses (EIF&E)	5210/01	Expert invoice for Fees and Expenses (EIF&E)
Firm Travel Voucher	5210/12	Firm Travel Voucher
Legal Invoice for Fees and Expenses	5210/11	Legal Invoice for Fees and Expenses
Legal Service Agreement (LSA)	5210/13	Legal Services Agreement
Legal Services Agreement (LSA) Amendment	5210/06	Legal Services Agreement (LSA) Amendment
Legal Support Services (LSS) Provider Budget Form	5210/15	Legal Support Services (LSS) Provider Budget Form
Legal Support Services (LSS) Provider Invoice for Fees and Expenses (IF&E)	5210/02	Legal Support Services (LSS) Provider Invoice for Fees and Expenses
Litigation Budget	5000/35	Litigation Budget
Non-Litigation Budget Form	5000/26	Non-Litigation Budget Form
Oral Representations and Certifications for Expert Legal Support Services	5210/14	Oral Representations for Certifications for Expert Legal Support Services
Outside Counsel Legal Services Agreement Rate Schedule	5210/10	Outside Counsel Legal Services Agreement Rate Schedule
Representations and Certifications for Legal Contractors	5200/01	Representations and Certifications for Legal Contractors
Reps and Certs for Experts and Legal Support Services Providers	5210/09	Reps and Certs for Experts and Legal Support Services Providers

---

ICR Summary of Burden

table that charts list of burden

	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	1,305	1,305	0	0	0	0
Annual Time Burden (Hours)	907	907	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/08/2021

---