Information Collection

FAST Levy Response Withhold Record Specifications: Multistate Financial Institutions

IC 211685 under ICR 201405-0970-002 · OMB 0970-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 FAST Levy Response Withhold Record Specifications: Multistate Financial Institutions	Form
1 FAST Levy Record Specs 0970-0196 FAST_Levy_Record Specifications.docx	Form

IC Title:

FAST Levy Response Withhold Record Specifications: Multistate Financial Institutions

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 303.7

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	1	FAST Levy Record Specs	0970-0196 FAST_Levy_Record Specifications.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	1,588	1,588
Annual IC Cost Burden (Dollars)	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.