Supporting Statement
FMS 1133
Justification
Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.
Payment Management (PM) requires that everyone who makes a claim of non-receipt against the United States for the Proceeds of a U. S. Treasury Check must complete a FMS 1133 claim form. The form is used to determine if a payee is entitled to the proceeds of the check. An initial handwriting examination is conducted using the signature specimens provided on the form (produced by the claimant) to determine if a forgery is involved. The FMS 1133 contains information found in 31 United States Code, Section 321 and 3331-3343, as to the authority of the Treasury Department to consider a claim. The FMS 1133 contains pertinent Privacy Act information.
Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.
Information presented to PM by the claimant on the FMS 1133 is required in order to process the individual claim for a payment obligation owed. A Legal Administrative Specialist can make a determination of forgery and then complete the necessary steps to settle the claim, or notify the program agency that the settlement of the claim is recommended. If the collection and analysis of the information provided on the claim form was not conduced, PM would have no basis with which to adjudicate the payee’s claim for the proceeds of the check.
Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.
No information systems or technologies have been developed and/or employed to reduce the reporting burden.
Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.
Similar data is not available from other agencies, or any other sources.
If the collection of information impacts small businesses or other small entities (Item 5 of OMB Form 83-I), describe any methods used to minimize burden.
The collection of information does not involve small businesses or other small entities.
Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.
The collection of information does not occur on a constant or fixed basis. It is only generated as an aftermath of a payee claiming entitlement to the proceeds of a U. S. Treasury check which he/she alleges not to have received. If the information is not collected from the claimant, the claim of non-receipt and/or forgery can not be substantiated.
Explain any special circumstances that would cause an information collection to be conducted in a manner: *requiring respondents to report information to the agency more often than quarterly; *requiring respondents to prepare a written response to a collection of information in fewer than 30 days after receipt of it; requiring respondents to submit more than an original and two copies of any document; etc.
There are no special circumstances that require the collection of data to be conducted in a manner consistent with the guidelines set forth in 5 CFR 1320.6.
If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the agency’s notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments. Specifically address comments received on cost and hour burden.
A pre-clearance notice was published in the Federal Register on February 4, 2010. There were no comments received as a result of the notice. There have been no consultations with parties outside the agency concerning this information collection.
Explain any decision to provide any payment or gift to respondents, other than re-enumeration of contractors or grantees.
There were no offers of payments or gifts to respondents for the collection of this information.
Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.
The FMS 1133 claim form requests information necessary under the authority of 31 USC Section 321 or 3331-3343, to consider a claim for non-receipt. The information is protected by the Privacy Act.
Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.
No questions of a sensitive, sexual or religious nature are contained on the FMS 1133.
Provide estimates of the hour burden of the collection of information. The statement should: *indicate the number of respondents, frequency of response, annual hour burden; and an explanation of how the burden was estimated.
Estimates of the burden of collection is as follows (FY 09 data):
A. Number of respondents 67,649
B. Frequency of responses 1
C. Total Annual Responses 67,649
D. Number of Hours Per Response 0.1667
E. Total Number of Burden Hours 11,277
Provide an estimate for the total annual cost burden to respondents or recordkeepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).
There is no cost to respondents. The respondent simply has to complete the claim form and to return it. There are no start-up or capital costs, or any other costs, to the respondent other than the cost of the postage to mail the claim form.
Provide estimates of annualized costs to the Federal government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operational expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies may also aggregate cost estimates from Items 12, 13, and 14 in a single table.
Estimates of annualized costs to the Federal Government (costs associated with the design, processing, and mailing, collecting data and printing of the form) are as follows:
Federal Government $377,500
Explain the reasons for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-I.
The increase in burden hours is an adjustment based on actual data gathered on the number of respondents.
For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.
There are no plans to externally publish the results of the collection information.
If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.
NA
Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submissions,” of OMB Form 83-I.
NA
Collection of Information Employing Statistical Methods
The collection of information does not employ statistical methods.
| File Type | application/msword |
| File Title | Supporting Statement |
| Author | rbrooks |
| Last Modified By | US Department of Treasury |
| File Modified | 2010-06-17 |
| File Created | 2010-06-17 |