(Electronic Pre-Printed Information), Claim Against the United States for the Proceeds of a Government Check

Forms and Documents

Document Name	Status
Form FMS 1133 FMS-1133 (Electronic Pre-Printed Information), Claim Against the United States for the Proceeds of a Government Check Form and Instruction	Modified
Support Stmt Quest 001907.doc Supporting Statement A	0000-00-00

IC Document Collections

IC ID	Document Title	Status
15380	FMS-1133 (Electronic Pre-Printed Information), Claim Against the United States for the Proceeds of a Government Check Form and Instruction	Modified

ICR Details

OMB Control No: 1510-0019	ICR Reference No: 200703-1510-003
Status: Historical Active	Previous ICR Reference No: 200402-1510-003
Agency/Subagency: TREAS/FMS	Agency Tracking No:
Title: (Electronic Pre-Printed Information), Claim Against the United States for the Proceeds of a Government Check
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/29/2007
	Date Received in OIRA: 03/29/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2010	36 Months From Approved	06/30/2007
Responses	52,874	0	62,877
Time Burden (Hours)	8,814	0	10,482
Cost Burden (Dollars)	0	0	0

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Abstract: The FMS-1133 form is used to collect information needed to process an individual's claim for non-receipt of proceeds from a government check. Once the information is analyzed, a determination is made and a recommendation to the program agency to either settle or deny the claim.

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Authorizing Statute(s): US Code: 31 USC Sec. 321, 3331-3343 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 74588	12/12/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 14643	03/28/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
FMS-1133 (Electronic Pre-Printed Information), Claim Against the United States for the Proceeds of a Government Check	FMS 1133	Claim Against the United States for the Proceeds of a Government Check

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ICR Summary of Burden

	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	52,874	62,877	0	0	-10,003	0
Annual Time Burden (Hours)	8,814	10,482	0	0	-1,668	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The decrease in burden hours is an adjustment based on actual data gathered on the number of respondents.

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Annual Cost to Federal Government: $530,341

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/29/2007

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