This form is required for payment of
regulatory fees, and for use when paying for ultiple fillings with
a single payment instrument, or when paying by credit card for
Federal benefits. The form requires specific information to track
payment history, and to facilitate the efficient and expeditious
processing of applications and other services by a lockbox bank.
The information will be used by the Commission for the purpose of
collecting and reporting on any delinquent amounts arising out of
such person's relationship with the Government.
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.