Information Collection

Notice of Claim & Proof of Loss, Working Capital Guarantee

IC 196187 under ICR 202312-3048-001 · OMB 3048-0035.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EIB 10-04 Notice of Claim & Proof of Loss, Working Capital Guarantee	Form and Instruction
Form EIB 10-04 NOTICE OF CLAIM AND PROOF OF LOSS – WORKING CAPITAL GUARANTEE Notice of Claim & Proof of Loss, Working Capital Guarantee	Form and Instruction
EIB 10-04 NOTICE OF CLAIM AND PROOF OF LOSS – WORKING CAPITAL GUAR EIB 10-04 Notice of Claim & Proof of Loss_Working Capital Guarantee.pdf img.exim.gov/s3fs-public/pub/pending/EIB+10-04+WCG+Notice+of+Claim+Proof+of+Loss+Sep+2023.pdf	Form and Instruction
EIB 10-04 NOTICE OF CLAIM AND PROOF OF LOSS – WORKING CAPITAL GUAR EIB 10-04 Notice of Claim & Proof of Loss_Working Capital Guarantee.pdf img.exim.gov/s3fs-public/pub/pending/EIB+10-04+WCG+Notice+of+Claim+Proof+of+Loss+Sep+2023.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

EIB 10-04

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320.5(a)(i)(iv)

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	EIB 10-04			https://img.exim.gov/s3fs-public/pub/pending/EIB+10-04+WCG+Notice+of+Claim+Proof+of+Loss+Sep+2023.pdf	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 2

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 60 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10	-7	17
Annual IC Time Burden (Hours)	60	43	17
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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