Supporting Statement of Ownership for Overdue United States Bearer Securities

Forms and Documents

Document	Type	Status	Availability
Form PD F 1071 Supporting Statement of Ownership for Overdue United States Bearer Securities	Form and Instruction	Modified	Available
Supporting_Statement_1071_REV.docx	Supporting Statement A	Uploaded 2012-11-09	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
16625	Supporting Statement of Ownership for Overdue United States Bearer Securities	Form and Instruction	Modified

ICR Details

OMB Control No: 1535-0102	ICR Reference No: 201205-1535-001
Status: Historical Active	Previous ICR Reference No: 200904-1535-005
Agency/Subagency: TREAS/BPD	Agency Tracking No:
Title: Supporting Statement of Ownership for Overdue United States Bearer Securities
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: 02/01/2013
	Date Received in OIRA: 07/11/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2016	36 Months From Approved	01/31/2013
Responses	900	0	1,000
Time Burden (Hours)	225	0	250
Cost Burden (Dollars)	0	0	0

---

Abstract: Used to establish ownership and support a request for payment.

---

Authorizing Statute(s): US Code: 31 USC 31 Name of Law: null
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 19057	03/29/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 40702	07/10/2012
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Supporting Statement of Ownership for Overdue United States Bearer Securities	PD F 1071	Supporting Statement Of Ownership For Overdue United States Bearer Securities

---

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	900	1,000	0	0	-100	0
Annual Time Burden (Hours)	225	250	0	0	-25	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 form is used in the redemption of Treasury securities held in paper form. This type of security is no longer issued so a decline in the use of the form is anticipated. The reduction of 25 burden hours is a program change due to agency discretion for a total of 225 hours requested.

---

Annual Cost to Federal Government: $1,868

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 07/11/2012

---