CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A GOVERNMENT CHECK

ICR 199410-1510-001

OMB: 1510-0019

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1510-0019 199410-1510-001
Historical Active 199106-1510-001
TREAS/FMS
CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A GOVERNMENT CHECK
Revision of a currently approved collection   No
Regular
Approved without change 01/19/1995
Retrieve Notice of Action (NOA) 10/28/1994
  Inventory as of this Action Requested Previously Approved
10/31/1997 10/31/1997 11/30/1994
120,192 0 127,677
20,072 0 21,323
0 0 0

IF A PAYEE CLAIMS NON-RECEIPT OF A TREASURY CHECK, THE FMS-1133 CLAIM FORM AND A COPY OF THE NEGOTIATED CHECK ARE SENT TO THE PAYEE. IF THE PAYEE WISHES TO CLAIM FORGERY, HE OR SHE ANSWERS QUESTIONS ON THE FORM AND SIGNS AND RETURNS IT TO THE ADJUDICATION DIVISION. CLAIMS EXAMINE REVIEW THE CLAIM TO DETERMINE FINAL ACTION ON THE CASE.

None
None


No

1
IC Title Form No. Form Name
CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A GOVERNMENT CHECK FMS-1133

  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 120,192 127,677 0 -7,485 0 0
Annual Time Burden (Hours) 20,072 21,323 0 -1,251 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
10/28/1994


© 2024 OMB.report | Privacy Policy