Contractor Representations and Certifications (Form 3700/04A)

Acquisition Services Information Requirements

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0072 can be found here:

Documents and Forms

Document Name Document Type
Form 3700/04A Contractor Representations and Certifications (Form 3700/04A) Form and Instruction
3700/04A Contractor Representations and Certifications 3700-04A; 20181220.doc www.fdic.gov Form and Instruction
3700/04A Contractor Representations and Certifications 3700-04A; 20181220.doc www.fdic.gov Form and Instruction

Information Collection (IC) Details

IC Title:	Contractor Representations and Certifications (Form 3700/04A)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 12 CFR 366

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3700/04A	Contractor Representations and Certifications	3700-04A; 20181220.doc	https://www.fdic.gov	Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: FDIC 30–64–0012 Financial Information Management Records	FR Citation: 80 FR 66981

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1	-11	12
Annual IC Time Burden (Hours)	1	-3	4
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.