7200/14 Declaration for Health and Welfare Plan

Forms Relating to Processing Deposit Insurance Claims

OMB: 3064-0143

IC ID: 243102

Information Collection (IC) Details

View Information Collection (IC)

7200/14 Declaration for Health and Welfare Plan
 
No Modified
 
Voluntary
 
12 CFR 330

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 7200/14 Declaration for Health and Welfare Plan _f7200-14.pdf Yes Yes Fillable Fileable Signable

Economic Development Financial Sector Oversight

FDIC 30-64-0013  80 FR 66981

12 0
   
Private Sector Businesses or other for-profits
 
   33 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 12 0 0 0 0 12
Annual IC Time Burden (Hours) 12 0 0 0 0 12
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Justification Memo Non-Substantive Change to 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.

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