Business Assistance Form

Customer Assistance Forms

Documents and Forms

Document Name Document Type
Form 6422/11 Business Assistance Form Form and Instruction
6422/11 Business Assistance Form Business Assistance Form (1).docx ask.fdic.gov/FDICBusinessAssistanceForm Form and Instruction
6422/11 Business Assistance Form (Spanish) Business Assistance Sp (1).docx ask.fdic.gov/FDICBusinessAssistanceForm?lang=esp_ES Form and Instruction

Information Collection (IC) Details

IC Title:	Business Assistance Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	6422/11	Business Assistance Form	Business Assistance Form (1).docx	https://ask.fdic.gov/FDICBusinessAssistanceForm	Yes	Yes	Fillable Fileable
Form and Instruction	6422/11	Business Assistance Form (Spanish)	Business Assistance Sp (1).docx	https://ask.fdic.gov/FDICBusinessAssistanceForm?lang=esp_ES	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,191	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,191	966	225
Annual IC Time Burden (Hours)	298	242	56
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.