Authorization to Furnish Financial Information and Certificate of Compliance

Forms and Documents

Document Name	Status
Form TTB F 5030.6 Authorization to Furnish Financial Information and Certificate of Compliance Form and Instruction	Modified
1513-0004 Supporting Statement (08-2025).docx Supporting Statement A	2025-08-12

IC Document Collections

IC ID	Document Title	Status
43832	Authorization to Furnish Financial Information and Certificate of Compliance Form and Instruction	Modified

ICR Details

OMB Control No: 1513-0004	ICR Reference No: 202508-1513-009
Status: Received in OIRA	Previous ICR Reference No: 202205-1513-003
Agency/Subagency: TREAS/TTB	Agency Tracking No: ICN 95 - 3/10
Title: Authorization to Furnish Financial Information and Certificate of Compliance
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/29/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2025
Responses	10	10
Time Burden (Hours)	3	3
Cost Burden (Dollars)	20	20

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Abstract: The Alcohol and Tobacco Tax and Trade Bureau (TTB), under its statutory and regulatory authorities, may require such applicants to show they have the financial standing necessary to conduct their operations in compliance with Federal law during an alcohol or tobacco permit application investigation. However, the Right to Financial Privacy Act of 1978 (the Act; 12 U.S.C. 3401 et seq.) limits the Federal Government’s access to the records of individuals held by financial institutions. The Act provides that a person may authorize a financial institution to disclose their individual records to a Federal agency, but it also requires the agency to certify to the institution that the agency has complied with the Act. To meet those requirements, a permit applicant uses TTB F 5030.6, Authorization to Furnish Financial Information and Certificate of Compliance, to authorize a financial institution to disclose their individual records to TTB, and TTB uses the form to certify to the institution that the agency has complied with the Act.

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Authorizing Statute(s): US Code: 12 USC 3401-3422 Name of Law: Right to Financial Privacy Act of 1978
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 20342	05/13/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 42305	08/29/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Authorization to Furnish Financial Information and Certificate of Compliance	TTB F 5030.6	Authorization to Furnish Financial Information and Certificate of Compliance

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10	10	0	0	0	0
Annual Time Burden (Hours)	3	3	0	0	0	0
Annual Cost Burden (Dollars)	20	20	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $328

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/29/2025

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