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Federal forms, ICRs, and supporting documents

OMB control number

Forms Relating to Processing Deposit Insurance Claims

OMB 3064-0143 · FDIC.

OMB 3064-0143

Depositors and deposit brokers with funds in failed institutions may be required to provide information about different "ownerships rights and capacities" and the amount of funds held in the institution. This information assists the FDIC in making determinations regarding deposit insurance coverage. The collection involves forms used by the FDIC to obtain information from depositors and deposit brokers necessary to supplement the records of failed insured depository institutions to make determinations regarding deposit insurance coverage. The information provided enables the FDIC to identify the actual owners of an account, each owner’s interest in the account, and the right and capacity in which the deposit is insured.

The latest form for Forms Relating to Processing Deposit Insurance Claims expires 2026-12-31 and is listed under ICR 202307-3064-006.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 7200/26 7200/26 Depositor InterviewForm and Instruction
Form 7200/24 7200/24 Claimant VerificationForm and Instruction
Form 7200/18 7200/18 Declaration for Irrevocable TrustForm and Instruction
Form 7200/15 7200/15 Declaration for Plan and TrustForm and Instruction
Form 7200/14 7200/14 Declaration for Health and Welfare PlanForm and Instruction
Form 7200/13 7200/13 Declaration for Custodian DepositForm and Instruction
Form 7200/12 7200/12 Declaration for defined Benefit PlanForm and Instruction
Form 7200/11 7200/11 Declaration for IRA/KEOGH DepositForm and Instruction
Form 7200/10 7200/10 Declaration for Defined Contribution PlanForm and Instruction
Form 7200/09 7200/09 Declaration for Testamentary Deposit (In Trust For or Payable on Death)Form and Instruction
Form 7200/08 7200/08 Declaration for Joint Ownership ReportForm and Instruction
Form 7200/07 7200/07 Declaration of Independent Activity for Unincorporated AssociationForm and Instruction
Form 7200/06 7200/06 Declaration of Independent ActivityForm and Instruction
Form 7200/05 7200/05 and 7200/27 - Declaration for Trust AccountForm and Instruction
Form 7200/04 7200/04 Declaration for Government DepositForm and Instruction
SPST 0143 Forms for Processing Deposit Insurance Claims 2023 Renewal FINAL.docxSupporting Statement A
FR2-0143 Forms Relating to Processing Deposit Insurance Claims 88 FR 65678 Sept 25 2023.pdf Supplementary Document
FR1-0143 Forms Relating to Processing Deposit Insurance Claims 88 FR 47503 JUkly 24 2023.pdf Supplementary Document
7200/26 Depositor Interview Form and Instruction
7200/24 Claimant Verification Form and Instruction
7200/18 Declaration for Irrevocable Trust Form and Instruction
7200/15 Declaration for Plan and Trust Form and Instruction
7200/14 Declaration for Health and Welfare Plan Form and Instruction
7200/13 Declaration for Custodian Deposit Form and Instruction
7200/12 Declaration for defined Benefit Plan Form and Instruction
7200/11 Declaration for IRA/KEOGH Deposit Form and Instruction
7200/10 Declaration for Defined Contribution Plan Form and Instruction
7200/09 Declaration for Testamentary Deposit (In Trust For or Payable on Death) Form and Instruction
7200/08 Declaration for Joint Ownership Report Form and Instruction
7200/07 Declaration of Independent Activity for Unincorporated Association Form and Instruction
7200/06 Declaration of Independent Activity Form and Instruction
7200/05 and 7200/27 - Declaration for Trust Account Form and Instruction
7200/04 Declaration for Government Deposit Form and Instruction
Exhibit B, The standard agency agreement, or the non-standard agency agreement Information collection
Exhibit A, Affidavit of Agency Account form Information collection
Electronic file on customers, "Broker Input File Requirements" Information collection
Deposit Broker Submission Checklist Information collection

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202307-3064-006 Extension without change of a currently approved collection 2023-09-26 Approved without change
202201-3064-010 No material or nonsubstantive change to a currently approved collection 2022-01-26 Approved without change
202111-3064-009 No material or nonsubstantive change to a currently approved collection 2021-11-19 Approved without change
202005-3064-002 Extension without change of a currently approved collection 2020-08-13 Approved without change
201705-3064-001 Revision of a currently approved collection 2017-05-23 Approved without change
201401-3064-001 Revision of a currently approved collection 2014-01-31 Approved with change
201301-3064-007 Extension without change of a currently approved collection 2013-05-13 Approved without change
200911-3064-003 Revision of a currently approved collection 2010-02-02 Approved without change
200806-3064-001 Extension without change of a currently approved collection 2008-06-19 Approved without change
200505-3064-002 Extension without change of a currently approved collection 2005-05-19 Approved without change
200204-3064-002 Existing collection in use without an OMB Control Number 2002-04-17 Approved without change

OMB Details

Deposit Broker Submission Checklist

Federal Enterprise Architecture: Economic Development - Financial Sector Oversight