Forms Relating to Processing Deposit Insurance Claims

ICR 202111-3064-009

OMB: 3064-0143

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2021-11-19
Supporting Statement A
2020-08-13
Supplementary Document
2020-08-07
Supplementary Document
2020-08-03
IC Document Collections
IC ID
Document
Title
Status
243112 Unchanged
243110 Modified
243106 Modified
243103 Modified
243102 Modified
243101 Modified
243100 Modified
243099 Modified
243096 Modified
243095 Modified
243093 Modified
243092 Modified
243091 Modified
243090 Modified
243089 Modified
226666
Unchanged
226665
Unchanged
226664
Unchanged
226663
Unchanged
ICR Details
3064-0143 202111-3064-009
Received in OIRA 202005-3064-002
FDIC
Forms Relating to Processing Deposit Insurance Claims
No material or nonsubstantive change to a currently approved collection   No
Regular 11/19/2021
  Requested Previously Approved
09/30/2023 09/30/2023
1,045 1,045
590 590
0 0

Depositors and deposit brokers with funds in failed institutions may be required to provide information about different "ownerships rights and capacities" and the amount of funds held in the institution. This information assists the FDIC in making determinations regarding deposit insurance coverage. The collection involves forms used by the FDIC to obtain information from depositors and deposit brokers necessary to supplement the records of failed insured depository institutions to make determinations regarding deposit insurance coverage. The information provided enables the FDIC to identify the actual owners of an account, each owner’s interest in the account, and the right and capacity in which the deposit is insured.

US Code: 12 USC 1821(a) and (f) Name of Law: Federal Deposit Insurance Act
  
None

Not associated with rulemaking

  85 FR 33667 06/02/2020
85 FR 47967 08/07/2020
No

19
IC Title Form No. Form Name
7200/04 Declaration for Government Deposit 7200/04 Declaration for Government Deposit
7200/05 Declaration for Trust 7200/05 Declaration for Trust
7200/06 Declaration of Independent Activity 7200/06 Declaration of Independent Activity
7200/07 Declaration of Independent Activity for Unincorporated Association 7200/07 Declaration of Independent Activity for Unincorporated Association
7200/08 Declaration for Joint Ownership Report 7200/08 Declaration for Joint Ownership Deposit
7200/09 Declaration for Testamentary Deposit (In Trust For or Payable on Death) 7200/09 Declaration for Testamentary Deposit (In Trust For or Payable on Death)
7200/10 Declaration for Defined Contribution Plan 7200/10 Declaration for Defined Contribution Plan
7200/11 Declaration for IRA/KEOGH Deposit 7200/11 Declaration for IRA/KEOGH Deposit
7200/12 Declaration for defined Benefit Plan 7200/12 Declaration for Defined Benefit Plan
7200/13 Declaration for Custodian Deposit 7200/13 Declaration for Custodian Deposit
7200/14 Declaration for Health and Welfare Plan 7200/14 Declaration for Health and Welfare Plan
7200/15 Declaration for Plan and Trust 7200/15 Declaration for Plan and Trust
7200/18 Declaration for Irrevocable Trust 7200/18 Declaration for Irrevocable Trust
7200/24 Claimant Verification 7200/24 Claimant Verification
7200/26 Depositor Interview 7200/26 Depositor Interview
Deposit Broker Submission Checklist
Diskette, following "Broker Input File Requirements"
Diskette, following "Broker Input File Requirements"
Exhibit B, the standard agency agreement, or the non-standard agency agreement

  Total Request 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 1,045 1,045 0 0 0 0
Annual Time Burden (Hours) 590 590 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
    Yes
    Yes
No
No
No
No
Manuel Cabeza 202 898-3781 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/19/2021


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