Justification Memo Non-Substantive Change to Deposit Insurance Claim Forms

Justification Memo 0143 -NS Revisions All Forms New DRO Address.docx

Forms Relating to Processing Deposit Insurance Claims

Justification Memo Non-Substantive Change to Deposit Insurance Claim Forms

OMB: 3064-0143

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Federal Deposit Insurance Corporation

550 17th Street NW, Washington, D.C. 20429-9990

550 17th Street NW, Washington, D.C. 20429-9990


November 19, 2021


 

Memorandum to: William Bestani

Policy Analyst

Office of Information and Regulatory Affairs

Office of Management and Budget

Executive Office of the President                            

                                    

From: Manny Cabeza

Regulatory Counsel

Assessments and Legislation Group

Legal Division

Federal Deposit Insurance Corporation      

     

RE: “Forms Relating to Processing Deposit Insurance Claims” (3064-0143) – Non-Substantive Revision of All Forms to Update New Address of FDIC Dallas Regional Office

FDIC is revising the following Forms associated with this information collection to update the mailing address of FDIC’s Dallas Regional Office which recently relocated to 600 North Pearl Street, Suite 700, Dallas, TX 75201. The change of the mailing address is necessary and is not substantive:

  • Form 7200/04 - Declaration of Government Deposit

  • Form 7200/05 – Declaration for Revocable Living Trust

  • Form 7200/06 – Declaration of Independent Activity

  • Form 7200/07 - Declaration of Independent Activity for Unincorporated Association

  • Form 7200/08 – Declaration for Joint Ownership Deposit

  • Form 7200/09 – Declaration for Testamentary Deposit

  • Form 7200/10 – Declaration for Defined Contribution Plan

  • Form 7200/11 – Declaration for IRA/Keogh Plan

  • Form 7200/12 – Declaration for Defined Benefit Plan

  • Form 7200/13 – Declaration for Custodian Deposit

  • Form 7200/14 - Declaration for Health and Welfare Plan

  • Form 7200/15 – Declaration for Plan and Trust

  • Form 7200/18 – Declaration for Irrevocable Trust

  • Form 7200/24 – Claimant Verification

If you have any questions, please let me know. Thank you for your consideration.




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