CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF GOVERNMENT CHECK OR CHECKS

ICR 198510-1510-002

OMB: 1510-0018

Federal Form Document

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ICR Details
1510-0018 198510-1510-002
Historical Active 198509-1510-002
TREAS/FMS
CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF GOVERNMENT CHECK OR CHECKS
Revision of a currently approved collection   No
Regular
Approved without change 12/05/1985
Retrieve Notice of Action (NOA) 10/08/1985
Approved with the following conditions: 1) a copy of the current transmittal letter for Form 1133C will be submitted to OMB no later than December 11, 1985, and 2) a request for clearance of the revised form combining Form 3858 (transmittal) and the current Form 1133C will be submitted for completion of OMB review action before a test of the new form is conducted. You are advised that provision must be made for inclusion of a Privacy Act/Paperwork Act notice on the revised form or instruction.
  Inventory as of this Action Requested Previously Approved
07/31/1986 07/31/1986 12/31/1985
1,663 0 1,663
416 0 416
0 0 0

THIS FORM IS SENT TO PAYEES WHEN AN ORIGINAL CHECK AND ITS SUBSTITUTE ISSUED IN LIEU THEREOF, HAVE BEEN NEGOTIATED BEARING DISSIMILAR ENDORSEMENTS. CHECK CLAIMS GROUP MUST GET A STATEMENT FROM THE PAYEE THAT THEY DID NOT CASH BOTH CHECKS. CHECK CLAIMS MAY THEN TAKE STEPS TO COLLECT THE OVERPAYMENT.

None
None


No

1
IC Title Form No. Form Name
CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF GOVERNMENT CHECK OR CHECKS 1133 'C'

  Total Approved 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 1,663 1,663 0 0 0 0
Annual Time Burden (Hours) 416 416 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/08/1985


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