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Federal forms, ICRs, and supporting documents

OMB control number

Certified Statement for Deposit Insurance Assessment

OMB 3064-0057 ยท FDIC.

OMB 3064-0057

The FDIC collects the quarterly deposit insurance payments by means of direct debits through the Automated Clearing House network. This information collection consists of statements supported by worksheets and reviewed by officials of the insured institutions to confirm that the assessment data is accurate.

The latest form for Certified Statement for Deposit Insurance Assessment expires 2026-09-30 and is listed under ICR 202311-3064-006.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 6420-07 Certified Statement for Deposit Insurance AssessmentForm and Instruction
Justification Memo Non Substantive Revisions 3064-0057 Novemebr 2023.docx Justification for No Material/Nonsubstantive Change
SPST 0057 Certified Statement of Semiannual Deposit Insurance Assessment 2023 Extension FINAL docx.docxSupporting Statement A
FR2 0057 Certified Statement of Semiannual Deposit Insurance Assessment 88 FR 44803 July 13 20223.pdf Supplementary Document
FR1 0057 Certified Statement of Semiannual Deposit Insurance Assessment 88 FR 27891 May 3 20223.pdf Supplementary Document
Certified Statement for Deposit Insurance Assessment Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202311-3064-006 No material or nonsubstantive change to a currently approved collection 2023-11-30 Approved without change
202304-3064-003 Extension without change of a currently approved collection 2023-07-13 Approved without change
202003-3064-002 Extension without change of a currently approved collection 2020-05-27 Approved without change
201609-3064-006 Revision of a currently approved collection 2016-12-06 Approved without change
201305-3064-002 Revision of a currently approved collection 2013-09-09 Approved without change
201008-3064-004 Extension without change of a currently approved collection 2010-08-23 Approved without change
200707-3064-003 Extension without change of a currently approved collection 2007-07-18 Approved without change
200406-3064-001 Revision of a currently approved collection 2004-06-01 Approved without change
200403-3064-004 No material or nonsubstantive change to a currently approved collection 2004-03-15 Approved without change
200208-3064-001 Extension without change of a currently approved collection 2002-08-22 Approved without change
199907-3064-001 Extension without change of a currently approved collection 1999-07-28 Approved without change
199606-3064-001 Revision of a currently approved collection 1996-06-19 Approved without change
199508-3064-001 Revision of a currently approved collection 1995-08-09 Approved without change
199406-3064-003 Revision of a currently approved collection 1994-06-01 Approved without change
199301-3064-001 Revision of a currently approved collection 1993-01-07 Approved without change
198912-3064-001 Revision of a currently approved collection 1989-12-28 Approved without change
198903-3064-003 No material or nonsubstantive change to a currently approved collection 1989-03-24 Approved with change
198703-3064-002 Extension without change of a currently approved collection 1987-03-02 Approved without change
198403-3064-002 Revision of a currently approved collection 1984-03-14 Approved without change
198109-3064-003 Revision of a currently approved collection 1981-09-24 Approved without change
198104-3064-057 Revision of a currently approved collection 1981-04-30 Approved without change