Analysis to Support Electronic Funds Transfer and Remittance Mandate

DEPARTMENT OF THE TREASURY

OMB No.: NNNN-XXXX
Exp. Date: XX/XX/XXXX

BUREAU OF THE FISCAL SERVICE
WASHINGTON, DC 20227

Script for Phone Survey
Hello, may I please speak with INSERT INDIVIDUAL’S NAME.
{If individual is not available, ask}: Is there a better time when I could call to speak with INSERT INDIVIDUAL’S
NAME?
{Record answer, note better calling time if applicable, and then say} Thank you so very much for your time.
{If person is available, then say}: I am conducting a survey about the ways people make payments to the federal
government. The US Treasury is currently evaluating how changes to the list of payment methods federal
agencies can accept might affect the public and individuals such as yourself. Would you be willing to
participate in our survey? The survey is expected to take approximately one hour to complete, but may
conclude in less time depending on the level of detail you choose to provide in response to each question.
Your input is extremely valuable.
{If answer is yes, proceed with survey. If answer is no, record answer, and then say} I thank you for your time.
Survey Questions:

1. Other than to pay taxes, what types of payments do you make to federal government agencies?
a. Insurance payments
b. Loan payments, such as to FEMA
c. Entrance to federal government property, such as National Park Service
d. Other
2. When you make one of these payments to a federal government agency, how do you submit
your payment? (Please state yes to all that apply.)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.

Cash
Money order
Check
Bank debit or direct transfer (ACH, etc.)
Credit card
Debit card
Prepaid card
Paypal or similar application
Text message from a cell phone
Wire transfer (such as MoneyGram or Western Union)
Other? (If so, please explain): _____________________

3. For each of the payment methods that you said you use when making a payment to the federal
government – and I will list them again for you – could you please tell me if you have to pay any
costs when using that form of payment and what the costs and/or burdens are to you? For
example, if you purchase a money order or a prepaid debit card, what is the extra amount that
you have to pay to purchase that money order or card? {ask only about those forms of payment

the respondent said in Question 2 that he/she uses.}
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.

Cash (description of expenses and amount ________________)
Money order (description of expenses and amount ________________)
Check (description of expenses and amount ________________)
Bank debit or direct transfer (ACH, etc.) (description of expenses and amount
________________)
Credit card (description of expenses and amount ________________)
Debit card (description of expenses and amount ________________)
Prepaid card (description of expenses and amount ________________)
Paypal or similar application (description of expenses and amount ________________)
Text message from a cell phone (description of expenses and amount
________________)
Wire transfer (such as MoneyGram or Western Union) (description of expenses and
amount ________________)
List out other form of payment mentioned in Question 2: _____________________
(description of expenses and amount ________________)

{Skip this question if respondent answered d, e, f, g, h, I, or j to Question 2}
4. If you could not use cash, money order, or a check to make a payment to the federal
government, what methods would you use? (Please state yes or no to each choice.)
a.
b.
c.
d.
e.
f.
g.
h.

Bank debit or direct transfer (ACH, etc.) _ yes _ no
Credit card _ yes _ no
Debit card _ yes _ no
Prepaid card _ yes _ no
Paypal or similar application _ yes _ no
Text message from a cell phone _ yes _ no
Wire transfer (such as MoneyGram or Western Union) _ yes _ no
Other? (If so, please explain): _____________________

5. Do you have a cell phone? _ yes _ no
a. Have you ever made a payment on a cell phone by sending a text message? _ yes _ no
b. Are there other ways you have used a cell phone to make a payment? _ yes _ no
If yes, please explain: _________________________________________
I am going to ask you a couple of questions about internet usage.

6. Please tell me the primary way you access the internet. Please choose only one.
a. Have internet access in my home or at a relative or friend’s home
b. Have internet access at work
c. Have internet access from a smartphone
d. Have internet access in my community (public library, café, etc.)
e. Do not have any internet access
7. Have you ever made a payment using the internet? _ yes _ no
If yes, did you have to pay anything extra to use the internet to make that payment? _ yes _ no
What were those costs? (type and amount) ______________________________
8. Do you ever need to submit forms or documentation along with your payment to a government
agency? _ yes _ no
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If yes, is there any fee or cost to submitting the documentation (examples might be
photocopying, buying an envelope, paying for postage, etc.) _ yes _ no
If yes, please describe the type of cost and the amount: _____________________________

Thank you very much for your time and input. Your participation in this survey is greatly appreciated.

Paperwork Reduction Act Statement of Burden
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless it displays a currently valid OMB control number. The time required to participate in this
information collection is estimated to average 60 minutes. Your response is voluntary. Comments concerning the
accuracy of the time estimate and suggestions for reducing this burden should be directed to the U.S. Department
of the Treasury, Bureau of the Fiscal Service, Washington DC 20227.

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