Supporting Statement
OMB No. 1510-0019
FMS 133
Justification
CIRCUMSTANCES NECESSITATING 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 133 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 133 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.
PURPOSE AND USE OF DATA
Information presented to PM by the claimant on the FMS 133 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.
CONSIDERATION GIVEN TO INFORMATION TECHNOLOGY
No information systems or technologies have been developed and/or employed to reduce the reporting burden.
EFFORTS TO IDENTIFY DUPLICATION
Similar data is not available from other agencies, or any other sources.
METHODS TO MINIMIZE BURDEN ON SMALL BUSINESSES OR OTHER SMALL ENTITIES
The collection of information does not involve small businesses or other small entities.
CONSEQUENCES OF NOT CONDUCTING COLLECTION
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 confirmation is not collected from the claimant, the claim of non-receipt and/or forgery cannot be substantiated.
SPECIAL CIRCUMSTANCES REQUIRING DATA COLLECTION TO BE INCONSISTENT WITH GUIDELINES IN 5 CFR 1320.5(d)(2)
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.
Consultation with individuals outside of the agency on availability of data, frequency of collection, clarity of instructions and forms, and data elements
A notice was published in the Federal Register on June 25, 2013, at 78 FR 38097. There were no comments received as a result of the notice.
EXPLANATION OF DECISION TO PROVIDE ANY PAYMENT OR GIFT TO RESPONDENT
There were no offers of payments or gifts to respondents for the collection of this information.
ASSURANCE OF CONFIDENTIALITY OF RESPONSES
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 to extent allow by law.
JUSTIFICATION OF SENSITIVE QUESTIONS
No questions of a sensitive, sexual or religious nature are contained on the FMS 1133.
ESTIMATED BURDEN OF INFORMATION COLLECTION
Estimates of the burden of collection is as follows (FY12 data):
No. of Respondents |
No. of Responses Per Respondent |
No. Annual Responses |
Hours Per Response |
Total Annual Burden |
27,640 |
1 |
27,640 |
0.1667 |
4,608 |
ESTIMATED TOTAL ANNUAL COST BURDEN TO RESPONDENTS
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.
ESTIMATED ANNUALIZED COST TO THE FEDERAL GOVERNMENT
Estimates of annualized costs to the Federal Government (costs associated with the design, processing, mailing, collecting data and printing of the form) is $340,000.
REASON FOR CHANGE IN BURDEN
The decrease in burden hours is an adjustment based on actual data gathered on the number of respondents.
PLANS FOR TABULATION, STATISTICAL ANALYSIS AND PUBLICATION
There are no plans to externally publish the results of the collection information.
REASONS WHY DISPLAYING THE OMB EXPIRATRION DATE IS INAPPROPRIATE
NA
EXCEPTIONS TO THE CERTIFICATION FOR THE PAPERWORK REDUCTION ACT SUBMISSION
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 | landre02 |
| Last Modified By | Wolfgang, Dawn |
| File Modified | 2013-09-09 |
| File Created | 2013-09-09 |