Legal Support Services (LSS) Provider Budget Form

• Legal Form Number: FDIC Form 5210/15
• Section: Federal Deposit Insurance Corporation

Page of FDIC 5210/15 (5-21)

OMB Number: 3064-0122

Expiration Date: 01/31/2023

Federal Deposit Insurance Corporation

LEGAL SUPPORT SERVICES (LSS) PROVIDER BUDGET

PAPERWORK REDUCTION ACT NOTICE

Public reporting burden for this collection of information is estimated to average 1.0 hour per response, including the time for reviewing

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection

of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including

suggestions for reducing this burden, to the Paper Reduction Act Clearance Officer, Legal Division, Federal Deposit Insurance

Corporation, 550 17th Street, N.W., Washington, D.C. 20429, and the Office of Management and Budget, Paperwork Reduction

Project (3064-0122), Washington, D.C. 20503. Any agency may not conduct or sponsor, and a person is not required to respond to, a

collection of information unless it displays a currently valid OMB control number.

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