Information Collection

Proof of Concept

IC 235499 under ICR 202507-3133-007 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Phase 1 Update 08.19.25 - CLEAN.pdf	Other-Screenshot - Web-based Applica
Phase 1 Update 08.19.25 - REDLINE.pdf Phase 1 Update 08.19.25 - REDLINE	IC Document

IC Title:

Proof of Concept

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 701 Apx B

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
Other-Screenshot - Web-based Application					Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	53	27	26
Annual IC Time Burden (Hours)	212	108	104
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Phase 1 Update 08.19.25 - REDLINE		08/20/2025

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

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