Justification for Change - FS 1201W-DFAS

Justification for Change

OMB # 1510-0077

Request for Payment of Federal Benefit by Check

EFT Waiver Form for the Defense Finance and Accounting Service (DFAS)

FS 1201W and FS 1201W-DFAS

The Defense Finance and Accounting Service (DFAS) has asked Treasury to assist them in reviewing and approving or rejecting requests by their recipients of a military benefit to continue receiving payment by check. The DFAS has requested minor changes to the form to accommodate the use by this category of recipient.

Fiscal Service will offer DFAS users the FS 1201W-DFAS, which is the same as the FS-1201W except for a few modifications to accommodate military benefits recipients. A check box selection for the type of recipient receiving the military benefit has been added and the recipient would identify the social security number of the deceased person if annuitant or former spouse.

We estimate an additional 250 DFAS respondents and an additional 83 burden hours.

	#Respondents	#Responses Per Respondent	Total Annual Responses	Hours Per Response	Total Annual Burden
FS 1201W	3000	1	3000	0.33	1,000
FS 1201W-DFAS	250	1	250	0.33	82.5
Totals	3,250	1	3,250	0.33	1,082.5

Also included with this request is a revised Form 1201W which identifies the new bureau acronym, FS for the Bureau of the Fiscal Service, and makes minor formatting changes.

May 2014