OMB NUMBER: 3064-0122
EXPIRATION DATE: 12/31/2019
FDIC 5210/03A (2-13)
Federal Deposit Insurance Corporation
AGREEMENT FOR SERVICES
(EXPERT/LEGAL SUPPORT SERVICES PROVIDER)
AMENDMENT (Continuation Sheet)
Page of
ADD (A)
or
DELETE (D)
BILLABLE INDIVIDUAL
(First, Middle, Last, Suffix)
Alphabetical Order
TIMEKEEPER ID TITLE
MINORITY
STATUS
Asian American (A)
Black American (B)
Hispanic American (H)
Native American Indian (N)
GENDER
(M or F)
HOURLY
RATE
FIXED
RATE
P
APERWORK 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, Room 3082, Federal Deposit Insurance Corporation, 550 17
th
Street,
N.W., Washington, DC 20429, and the Office of Management and Budget, Paperwork Reduction Project (3064-0122), Washington, D.C. 20503. An agency may not conduct or sponsor, and a person is n
ot
required to
respond to, a collection of information unless it displays a currently valid OMB control number.
