Information Collection

Integrity and Fitness Representations (Form 1600/12)

IC 185892 under ICR 202308-3064-003 · OMB 3064-0072.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3700/12 Integrity and Fitness Representations (Form 1600/12)	Form and Instruction
3700/12 Integrity and Fitness Representations and Certifications 3700-12; 20230328 (AA).pdf www.fdic.gov	Form and Instruction
3700/12 Integrity and Fitness Representations and Certifications 3700-12; 20230328 (AA).pdf www.fdic.gov	Form and Instruction
3064-0072 Justification for Non-Substantive Forms Revision Procurement Certs 2023 Certifications.docx Justification for Non-Substantive Change	IC Document
3064-0072 Justification for Non-Substantive Forms Revision Procurement Certs 2023 Certifications.docx Justification for Non-Substantive Change	IC Document

IC Title:

Integrity and Fitness Representations (Form 1600/12)

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:

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	3700/12	Integrity and Fitness Representations and Certifications	3700-12; 20230328 (AA).pdf	https://www.fdic.gov	Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title: FDIC 30â64â0012 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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification for Non-Substantive Change	3064-0072 Justification for Non-Substantive Forms Revision Procurement Certs 2023 Certifications.docx	08/08/2023

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