Information Collection

Certification of Compliance with Mandatory Bars to Employment

IC 31915 under ICR 202108-3064-004 · OMB 3064-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0121 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDIC-2120/16 Certification of Compliance with Mandatory Bars to Employment	Form
FDIC-2120/16 Applicant Certification Statement Form 2120-16 Applicant Certification.pdf	Form
FDIC-2120/16 Applicant Certification Statement Form 2120-16 Applicant Certification.pdf	Form

IC Title:

Certification of Compliance with Mandatory Bars to Employment

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 12 CFR Part 336, Subpart B (To search for a specific CFR, visit the Code of Federal Regulations.)

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	FDIC-2120/16	Applicant Certification Statement	Form 2120-16 Applicant Certification.pdf		Yes	Yes	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: 30-64-0015 Personnel Records

FR Citation: 80 FR 66982

Number of Respondents: 528

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	528	28	500
Annual IC Time Burden (Hours)	88	5	83
Annual IC Cost Burden (Dollars)	0	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.