Federal Deposit Insurance Corporation - Legal Invoice for Fees and Expenses - Form 5210/11

Sep 21, 2026

Upload by Paura

Federal Deposit Insurance Corporation legal invoice form for reporting fees and expenses. Includes paperwork reduction act notice and instructions to provide required information. Sections collect institution details, law firm information, current billing data (invoice number, billing period, fees, expenses, and totals), and a certification by an authorized law firm representative. Designed for accurate itemization and submission of legal charges consistent with the Legal Services Agreement and Outside Counsel Deskbook.

LanguageEnglish

CategoryInvoices

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

Paperwork Reduction Act Notice

Section I - Institution Information

Section II - Law Firm Information

Section III - Current Billing Information

Section IV - Authorized Law Firm Representative Certification

# Federal Deposit Insurance CorporationLEGAL INVOICE FOR FEES AND EXPENSES 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 reviewinginstructions,searching existing data sources,gathering and maintaining the data needed,completing and reviewing the collection ofinformation.Send comments regarding this burden estimate or any other aspect of this collection of information,including suggestionsfor reducing this burden to the Paper Reduction Act Clearance Officer,Legal Division,Federal Deposit Insurance Corporation,55017th Street,N.W.,Washington,D.C.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 not required to respond to a collection ofinformation unless it displays a currently valid OMB control. Page down to access form 5210/11 # Federal Deposit Insurance CorporationLEGAL INVOICE FOR FEES AND EXPENSES INSTRUCTIONS:Please provide all information requested. ## SECTIONI-INSTITUTION INFORMATION 1.Matter Number 2.Matter Caption | 3.Name of Institution | 4.Institution Number | | --- | --- | | | | 5.Address (Street,City,State,ZIP Code) ## SECTIONⅡ-LAW FIRM INFORMATION | 6.Firm's Name | | 7.Federal Tax Number | | --- | --- | --- | | | | | | 8.Address (Street,City,State,ZIP Code) | | 9.Vendor Number | | | | | | 0.Law Firm Contact Attorney | | 11.Telephone | | | | | | 12.Law Firms Accounts Receivable Contact | | 13.Telephone | | | | | | 14.FDIC Office Location | 15.FDIC Attorney | 16.Telephone | | | | | ## SECTIONⅢ-CURRENT BILLING INFORMATION | 17.Invoice Number | 18.Billing Period Date
To:
From: | | --- | --- | | | | 19.Complete the following. | Fees Billed | Expenses Billed | Total | | --- | --- | --- | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Grand Total | | | ## SECTION IV-AUTHORIZED LAW FIRM REPRESENTATIVE CERTIFICATION I cerify that the information contained herein is true and correct to the best of my knowledge,information,and belief,and thatallcharges for legal services and disbursements reflected herein are in accordance with our Legal Services Agreement with the Legal Division and the Division's Outside Counsel Deskbook. | 20.Name | 21.Title | | --- | --- |

FAQs

What information must be provided on this FDIC legal invoice form?

The form requires institution information, law firm information, current billing details (invoice number, billing dates, fees billed, expenses billed, and totals), and a representative certification.

What does the paperwork reduction act notice require?

It states estimated public reporting burden, explains how comments can be submitted to the Paperwork Reduction Act Clearance Officer and the Office of Management and Budget, and notes that response is not required without a valid OMB control.

Who must certify the invoice and what are they certifying?

An authorized law firm representative must certify that the information is true and correct and that charges for legal services and disbursements match the Legal Services Agreement and the Outside Counsel Deskbook.

Sep 21, 2026

Upload by Paura