Information Collection

Leasing Representations and Certifications

IC 185905 under ICR 201511-3064-008 · OMB 3064-0072.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0072 can be found here:

Documents and Forms

Document Name Document Type
Form 3700-04A Leasing Representations and Certifications Form and Instruction
3700-04A Contractor Representations and Certifications 3700-04A (New Form).doc www.fdic.gov/formsdocuments/3700-44.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Leasing Representations and Certifications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 366

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3700-04A	Contractor Representations and Certifications	3700-04A (New Form).doc	https://www.fdic.gov/formsdocuments/3700-44.doc	Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	35	35
Annual IC Time Burden (Hours)	35	35
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.