Information Collection

Check Sample Survey (FR 3066c)

IC 205090 under ICR 201211-7100-006 · OMB 7100-0351.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 7100-0351 can be found here:

Documents and Forms

Document Name Document Type
Form FR 3066c Check Sample Survey (FR 3066c) Form and Instruction
FR 3066c Check Sample Survey FR3066c_20121214_survey.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Check Sample Survey (FR 3066c)	Agency IC Tracking Number:	FR 3066c

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FR 3066c	Check Sample Survey	FR3066c_20121214_survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.