Information Collection

Certification of Compliance with Mandatory Bars to Employment

IC 31915 under ICR 202412-3064-001 · OMB 3064-0121.

Documents and Forms

Document Name Document Type
Form FDIC-2120/16 Certification of Compliance with Mandatory Bars to Employment Form
FDIC-2120/16 Applicant Certification Statement 2120-16; 20241209 (R).pdf Form
FDIC-2120/16 Applicant Certification Statement 2120-16; 20241209 (R).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification of Compliance with Mandatory Bars to Employment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 12 CFR Part 336, Subpart B (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FDIC-2120/16	Applicant Certification Statement	2120-16; 20241209 (R).pdf		Yes	Yes	Fillable Printable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: 30-64-0015 Personnel Records	FR Citation: 84 FR 35184

Number of Respondents: 866	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	866	338	528
Annual IC Time Burden (Hours)	144	56	88
Annual IC Cost Burden (Dollars)	0	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.