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Federal forms, ICRs, and supporting documents

OMB control number

Customer Assistance Forms

OMB 3064-0134 ยท 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.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 6422/04 Customer AssistanceForm and Instruction
Form 6422/15 Deposit Insurance InquiryForm and Instruction
Form 6422/11 Business Assistance FormForm and Instruction
SPST-0134 - Customer Assistance - 2024 Renewal.docxSupporting Statement A
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
Customer Assistance Form and Instruction
Deposit Insurance Inquiry Form and Instruction
Business Assistance Form Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
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
FormNameElectronic accessType
Form 6422/04Customer Assistance Formask.fdic.gov/FDICCustomerAssistanceForm/Form and instruction
Form 6422/04Customer Assistance Form (Spanish)ask.fdic.gov/FDICCustomerAssistanceForm/FDICCustomerAssistanceForm?lang=esp_ESForm and instruction

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