Information Collection

Business Assistance Form

IC 202928 under ICR 202109-3064-007 · OMB 3064-0134.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0134 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6422/11 Business Assistance Form	Form and Instruction
6422/11 Business Assistance Form Business Assistance Form (1).docx ask.fdic.gov/FDICBusinessAssistanceForm	Form and Instruction
6422/11 Business Assistance Form Business Assistance Form (1).docx ask.fdic.gov/FDICBusinessAssistanceForm	Form and Instruction
6422/11 Business Assistance Form (Spanish) Business Assistance Sp (1).docx ask.fdic.gov/FDICBusinessAssistanceForm?lang=esp_ES	Form and Instruction
6422/11 Business Assistance Form (Spanish) Business Assistance Sp (1).docx ask.fdic.gov/FDICBusinessAssistanceForm?lang=esp_ES	Form and Instruction

IC Title:

Business Assistance Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	6422/11	Business Assistance Form	Business Assistance Form (1).docx	https://ask.fdic.gov/FDICBusinessAssistanceForm	Yes	Yes	Fillable Fileable
Form and Instruction	6422/11	Business Assistance Form (Spanish)	Business Assistance Sp (1).docx	https://ask.fdic.gov/FDICBusinessAssistanceForm?lang=esp_ES	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	225	25	200
Annual IC Time Burden (Hours)	56	6	50
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.