Forms Relating to Processing Deposit Insurance Claims

OMB 3064-0143

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 2023-09-30 and can be found here.

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7200/04 – Declaration for Government Deposit

Federal Enterprise Architecture: Economic Development - Financial Sector Oversight

Form 7200-04Declaration for Government Depositwww.fdic.gov/regulations/laws/forms/claims.htmlForm and instruction

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