Information Collection

Integrity and Fitness Representations (Form 1600/12)

IC 185892 under ICR 202308-3064-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 3700/12 Integrity and Fitness Representations (Form 1600/12) Form and Instruction
3700/12 Integrity and Fitness Representations and Certifications 3700-12; 20230328 (AA).pdf www.fdic.gov Form and Instruction
3700/12 Integrity and Fitness Representations and Certifications 3700-12; 20230328 (AA).pdf www.fdic.gov Form and Instruction
3064-0072 Justification for Non-Substantive Forms Revision Procurement Certs 2023 Certifications.docx Justification for Non-Substantive Change IC Document
3064-0072 Justification for Non-Substantive Forms Revision Procurement Certs 2023 Certifications.docx Justification for Non-Substantive Change IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Integrity and Fitness Representations (Form 1600/12)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	3700/12	Integrity and Fitness Representations and Certifications	3700-12; 20230328 (AA).pdf	https://www.fdic.gov	Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: FDIC 30â64â0012 Financial Information Management Records	FR Citation: 80 FR 66981

Number of Respondents: 1	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	1	1
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification for Non-Substantive Change	3064-0072 Justification for Non-Substantive Forms Revision Procurement Certs 2023 Certifications.docx	08/08/2023

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