Deposit Insurance Inquiry

Customer Assistance Forms

Documents and Forms

Document Name Document Type
Form 6422/15 Deposit Insurance Inquiry Form and Instruction
6422/15 Deposit Insurance Form FDIC Deposit Insurance Form (1) (2).docx ask.fdic.gov/FDICDepositInsuranceForm Form and Instruction
6422/15 Deposit Insurance Form (Spanish) Deposit Insurance Sp (1).docx ask.fdic.gov/FDICDepositInsuranceForm?lang=esp_ES Form and Instruction

Information Collection (IC) Details

IC Title:	Deposit Insurance Inquiry	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	6422/15	Deposit Insurance Form	FDIC Deposit Insurance Form (1) (2).docx	https://ask.fdic.gov/FDICDepositInsuranceForm	Yes	Yes	Fillable Fileable
Form and Instruction	6422/15	Deposit Insurance Form (Spanish)	Deposit Insurance Sp (1).docx	https://ask.fdic.gov/FDICDepositInsuranceForm?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: 1,465	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	1,465	554	911
Annual IC Time Burden (Hours)	366	138	228
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.