Fillable 5210-06a FDIC 5210/06A(E), Legal Services Agreement E-Billing Amendment (Continuation Sheet)

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5210-06a FDIC 5210/06A(E), Legal Services Agreement E-Billing Amendment (Continuation Sheet)

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OMB NUMBER: 3064-0122
EXPIRATION DATE: 12/31/2019
Federal Deposit Insurance Corporation
LEGAL SERVICES AGRE
EMENT (LSA) AMENDMENT
(Continuation Sheet)
Page of
NAME OF LAW FIRM
BRANCH/OFFICE LOCATION
A (ADD)
OR
D (DELETE)
BILLABLE INDIVIDUAL
(First Middle Last)
Alphabetical Order
TIMEKEEPER
ID
STATE
LICENSES
POSITION
YEARS IN
PRACTICE
GENDER
(M or F)
STANDARD
RATE
PERCENT
(%)
DISCOUNT
PROPOSED
FDIC
RATE
P (Partner)
A (Associate)
PP (Paraprofessional)
O (Other) - specify
B (Black American)
H (Hispanic American)
PAPERWORK REDUCTION ACT NOTICE: Public reporting 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 Paperwork Reduction Act Clearance Officer, Legal Division, Federal Deposit Insurance Corporation, 550 17
th
Street, N.W., Washington, DC
20429; and to the Office of Management and Budget, Paperwork Reduction Project (3064-0122), Washington, DC 20503. An 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.
FDIC 5210/06A-E (6-12)
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5210-06a FDIC 521006A(E), Legal Services Agreement E-Billing Amendment (Continuation Sheet)

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Completed 10 March 2020

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