Information Collection

7200/04 Declaration for Government Deposit

IC 243089 under ICR 202111-3064-009 · OMB 3064-0143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0143 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 7200/04 7200/04 Declaration for Government Deposit	Form and Instruction
7200/04 Declaration for Government Deposit _f7200-04.pdf	Form and Instruction
7200/04 Declaration for Government Deposit _f7200-04.pdf	Form and Instruction
Justification Memo 0143 -NS Revisions All Forms New DRO Address.docx Justification Memo for Non-Substantive Change Deposit Insurance Claim Forms	IC Document
Justification Memo 0143 -NS Revisions All Forms New DRO Address.docx Justification Memo for Non-Substantive Change Deposit Insurance Claim Forms	IC Document

IC Title:

7200/04 Declaration for Government Deposit

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 12 CFR 330

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	7200/04	Declaration for Government Deposit	_f7200-04.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: FDIC 30-64-0013

FR Citation: 80 FR 66981

Number of Respondents: 14

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 33 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	14	14
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification Memo for Non-Substantive Change Deposit Insurance Claim Forms	Justification Memo 0143 -NS Revisions All Forms New DRO Address.docx	11/19/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.