Form 5000/26 Non-Litigation/Transactional Budget Form

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OMB NUMBER: 3064-0122
EXPIRATION DATE: 07/31/2013

Federal Deposit Insurance Corporation

NON-LITIGATION BUDGET FORM
INSTRUCTIONS: Please provide all information requested.
Matter Number

Matter Caption

Institution Number

Institution Type

Institution Name

Bank

Firm Name

Thrift

PART I - NON-LITIGATION BUDGET INFORMATION
Attorneys' Fees:

Estimated Recovery Value:

Hourly Rate: $ ___________

$

.

Fixed Fee: $ _______________\
TOA Fee: $ ______________.
Contingent Fee: ___________ % of $ ______________
Specify Nature of Non-Litigation work to be Performed (Attach additional sheet(s) as necessary.)

Estimated Hours for Completion:

Fees

.

Estimated Completion Date (MM/DD/YYYY):

Expenses

Total

.

PART II - LAW FIRM BUDGET ACKNOWLEDGMENT
I acknowledge that the budget information contained herein is correct to the best of my knowledge and written approval of the
Legal Division is required for any increase in the total budget amount.
Authorized Law Firm Delegate’s Signature
Date (MM/DD/YYYY)
Name and Title of Authorized Law Firm Delegate (Please type or print)
Telephone Number (Include area code)

FAX (Include area code)

PART III - BUDGET AUTHORIZATION FOR OUTSIDE COUNSEL TO PROCEED
FDIC Attorney (Recommending approval of budget)

Date Budget Approved (MM/DD/YYYY)

Signature of Delegated Authority

Date Budget Approved (MM/DD/YYYY)

PAPERWORK REDUCTION ACT NOTICE
Public reporting burden for this collection of information is estimated to average 0.5 hours 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 to 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 of information unless it displays a
currently valid OMB control number.
FDIC 5000/26 (10-05)

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