Change Notice to ADD Direct Express Card Sign-Up Forms

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Financial Management Service

memorandum

Date:

September 8, 2011

To:

J. Wesley Powe, Manager
Records and Information Management Branch

From:

Sheryl R. Morrow
0/l;\i
Assistant Commissioner
Payment Management

Subject:

OMB 83-C Paperwork Reduction Act Change Notice for
FMS Forms FMS1201L and FMS1201S Direct Express® Card Sign-Up
Form for Direct Deposit of Labor, Social Security and Supplemental
Security Federal Benefit Payments
(OMB Control No. 1510-0007)

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For submission to the Office of Management and Budget (OMB), through the Department,
attached is Form 83-C, notifying OMB of non-material changes to a previously approved
collection of information related to direct deposit enrollment (OMB Control Number 15100007). All of the elements of information collected via the new FMS 1201L and 1201S have
been approved, except these forms which allow Labor- Black Lung, Social Security, and
Supplemental Security check recipients to sign up to receive monthly benefits via the Direct
Express® Card instead of a check.
The new element is not a material change to the collection of information previously approved
by OMB (see SF-1199A and FMS Form 1200, 1200 VADE submissions) and does not represent
any burden increase. Therefore, I request that the attached Form 83-C be submitted to OMB for
informational purposes only.
If you have any questions regarding this form submission, please direct them to
Edita Rickard on 874-7165.
Attachments:

FMS -

PRA Submission, OMB 83-C (with attachments)
Copy of the FMS Form 1201L and 1201S

Quality People -

Quality Service