OMB control number

Customer Assistance Forms

OMB 3064-0134 · FDIC.

OMB 3064-0134

This collection facilitates the collection of information from customers of financial institutions that have inquiries or complaints about service. Customers or businesses may document their complaints or inquiries to the FDIC using a letter or optional forms (Form 6422/04; Form 6422/11; Form 6422/15). The Forms are used to facilitate online completion and submission of the complaints or inquiries and to shorten FDIC response times by making it easier to identify the nature of the complaint and to route the customer or business inquiry to the appropriate FDIC contact.

The latest form for Customer Assistance Forms expires 2028-01-31 and is listed under ICR 202410-3064-002.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 6422/04 Customer Assistance Form (Spanish)	Form and Instruction
Form 6422/04 Customer Assistance Form	Form and Instruction
Form 6422/04 Customer Assistance	Form and Instruction
Form 6422/15 Deposit Insurance Form (Spanish)	Form and Instruction
Form 6422/15 Deposit Insurance Form	Form and Instruction
Form 6422/15 Deposit Insurance Inquiry	Form and Instruction
Form 6422/11 Business Assistance Form (Spanish)	Form and Instruction
Form 6422/11 Business Assistance Form	Form and Instruction
Form 6422/11 Business Assistance Form	Form and Instruction
PC_202410-3064-002_111824_015800_1.pdf (document unavailable)	Public Comments
PC_202410-3064-002_111824_020017_1.pdf (document unavailable)	Public Comments
SPST-0134 - Customer Assistance - 2024 Renewal.docx	Supporting Statement A
SPST-0134 - Customer Assistance - 2024 Renewal.docx	Supporting Statement A
FR2 0134 Customer Assistance Forms 89 FR 84136 Oct 21 2024.pdf	Supplementary Document
FR2 0134 Customer Assistance Forms 89 FR 84136 Oct 21 2024.pdf	Supplementary Document
FR1 0134 = Customer Assistance Forms 89 FR 67635 Aug 21 2024.pdf	Supplementary Document
FR1 0134 = Customer Assistance Forms 89 FR 67635 Aug 21 2024.pdf	Supplementary Document
Customer Assistance	Form and Instruction
Customer Assistance	Form and Instruction
Customer Assistance	Form and Instruction
Deposit Insurance Inquiry	Form and Instruction
Deposit Insurance Inquiry	Form and Instruction
Deposit Insurance Inquiry	Form and Instruction
Business Assistance Form	Form and Instruction
Business Assistance Form	Form and Instruction
Business Assistance Form	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202410-3064-002	Extension without change of a currently approved collection	2024-10-30
202109-3064-007	Extension without change of a currently approved collection	2021-11-29	Approved without change
201809-3064-005	Extension without change of a currently approved collection	2018-09-28	Approved without change
201707-3064-002	No material or nonsubstantive change to a currently approved collection	2017-07-19	Approved without change
201506-3064-002	Extension without change of a currently approved collection	2015-06-25	Approved without change
201206-3064-007	Revision of a currently approved collection	2012-07-02	Approved without change
200904-3064-001	Revision of a currently approved collection	2009-04-17	Approved without change
200602-3064-004	Extension without change of a currently approved collection	2006-02-23	Approved without change
200301-3064-001	Extension without change of a currently approved collection	2003-01-16	Approved without change
199911-3064-001	New collection (Request for a new OMB Control Number)	1999-11-04	Approved without change

OMB Details

Customer Assistance

Federal Enterprise Architecture: Economic Development - Financial Sector Oversight

Information collection instruments
Form	Name	Electronic access	Type
Form 6422/04	Customer Assistance Form	ask.fdic.gov/FDICCustomerAssistanceForm/	Form and instruction
Form 6422/04	Customer Assistance Form (Spanish)	ask.fdic.gov/FDICCustomerAssistanceForm/FDICCustomerAssistanceForm?lang=esp_ES	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.