Information Collection

Contractor Representations and Certifications (Form 3700/04A)

IC 187308 under ICR 202503-3064-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 3700/04A Contractor Representations and Certifications (Form 3700/04A)	Form and Instruction
Form 3700/04A Contractor Representations and Certifications Contractor Representations and Certifications (Form 3700/04A)	Form and Instruction
3700/04A Contractor Representations and Certifications 3700-04A; 20181220.doc www.fdic.gov	Form and Instruction
3700/04A Contractor Representations and Certifications 3700-04A; 20181220.doc www.fdic.gov	Form and Instruction

IC Title:

Contractor Representations and Certifications (Form 3700/04A)

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	3700/04A			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)	1	1
Annual IC Cost Burden (Dollars)	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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