Information Collection

Agreement for Services (expert or Legal Support Services Provider) Provider Rate Schedule

IC 238896 under ICR 202107-3064-002 · OMB 3064-0122.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3064-0122 can be found here:

Documents and Forms

Document Name Document Type
Form 5210/04 Agreement for Services (expert or Legal Support Services Provider) Provider Rate Schedule Form
5210/04 Agreement for Services (expert or Legal Support Service f5210-04.pdf Form
5210/04 Agreement for Services (expert or Legal Support Service f5210-04.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Agreement for Services (expert or Legal Support Services Provider) Provider Rate Schedule	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 361 12 CFR 366

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5210/04	Agreement for Services (expert or Legal Support Service Provider) Provider Rate Schedule	f5210-04.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: 100	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	100	100
Annual IC Time Burden (Hours)	100	100
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.