Form 1201W Request for Payment of Federal Benefits by Check

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The time required to complete this information collection is estimated to
average 20 minutes, including the time to review instructions, search existing data resources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Comments concerning the accuracy of
the time estimate and suggestions for reducing this burden should be directed to the Department of the Treasury, Bureau of the Fiscal Service, Washington DC 20005.