Information Collection

FMS-1133 (Electronic Pre-Printed Information), Claim Against the United States for the Proceeds of a Government Check

IC 15380 under ICR 201003-1510-005 · OMB 1510-0019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1510-0019 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FMS 1133 Claim Against the United States for the Proceeds of a Government Check FMS-1133 (Electronic Pre-Printed Information), Claim Against the United States for the Proceeds of a Government Check	Form and Instruction
FMS 1133 Claim Against the United States for the Proceeds of a Go ROCISForm 1133.pdf	Form and Instruction

IC Title:

FMS-1133 (Electronic Pre-Printed Information), Claim Against the United States for the Proceeds of a Government Check

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FMS 1133				No		Paper Only

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 67,649

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	67,649	14,775	52,874
Annual IC Time Burden (Hours)	11,278	2,464	8,814
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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