Information Collection

EFT Waiver Form

IC 202118 under ICR 201407-1530-021 · OMB 1530-0019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1530-0019 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FMS 1201W (SP) EFT Waiver Form	Form and Instruction
FMS 1201W (SP) Solicitud Para Recibir Su Pago de Beneficios Federales E FMS 1201-W (SP) JUN2013.pdf	Form and Instruction
FS Form 1201W Request for Payment of Federal Benefits by Check FS Form 1201W_REV_MAR2014.pdf	Form and Instruction

IC Title:

EFT Waiver Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 31 CFR Part 208 (To search for a specific CFR, visit the Code of Federal Regulations.)

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 and Instruction	FMS 1201W (SP)	Solicitud Para Recibir Su Pago de Beneficios Federales En Cheque	FMS 1201-W (SP) JUN2013.pdf		Yes	No	Fillable Printable
Form and Instruction	FS Form 1201W	Request for Payment of Federal Benefits by Check	FS Form 1201W_REV_MAR2014.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title: Direct Deposit Enrollment Records-Treasury/FMS .006

FR Citation: 76 FR 42765

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	1,380	1,380

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.