EFT Waiver Form - DFAS

Request for Payment of Federal Benefit by Check, EFT Waiver Form

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form FS Form 1201W-DFAS EFT Waiver Form - DFAS Form and Instruction
FS Form 1201W-DFAS Request for Payment by Federal Benefits Check FS_Form_1201WDFAS.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	EFT Waiver Form - DFAS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FS Form 1201W-DFAS	Request for Payment by Federal Benefits Check	FS_Form_1201WDFAS.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: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	250	0	250
Annual IC Time Burden (Hours)	83	0	83
Annual IC Cost Burden (Dollars)	123	123	0

Documents for IC

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.