FS Form 2887 - Application Form for U.S. Department of the Treasury Stored Value Card (SVC) Program

Forms and Documents

Document Name	Status
Form FS Form 5752 Authorization to Disclose Information Related To Stored Value Account Form and Instruction	New
Form FS Form 2887 Application Form for U.S. Department of the Treasury Stored Value Card (SVC) Form and Instruction	Modified
1530-0013_Support_StatementFINAL.docx Supporting Statement A	2016-09-09

IC Document Collections

IC ID	Document Title	Status
223474	Authorization to Disclose Information Related To Stored Value Account Form and Instruction	New
207481	Application Form for U.S. Department of the Treasury Stored Value Card (SVC) Form and Instruction	Modified

ICR Details

OMB Control No: 1530-0013	ICR Reference No: 201609-1530-001
Status: Historical Active	Previous ICR Reference No: 201407-1530-015
Agency/Subagency: TREAS/FISCAL	Agency Tracking No:
Title: FS Form 2887 - Application Form for U.S. Department of the Treasury Stored Value Card (SVC) Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/02/2017
	Date Received in OIRA: 09/22/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved	06/30/2017
Responses	60,030	0	60,000
Time Burden (Hours)	10,001	0	10,000
Cost Burden (Dollars)	0	0	0

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Abstract: This form is used to collect information from individuals requesting enrollment in the Treasury SVC program, to obtain authorization to initiate debit and credit entries to their bank or credit union accounts to load value on the cards, and to facilitate collection of any delinquent amounts that may become due and owing as a result of the use of the cards.

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Authorizing Statute(s): PL: Pub.L. 104 - 134 et al. Name of Law: Debt Collection Improvement Act of 1996
   US Code: 31 USC 1322 Name of Law: Payments of unclaimed trust fund amounts and refund of amounts erroneously deposited
   US Code: 5 USC 5514 Name of Law: Installment deduction for indebtedness to the United States
   US Code: 31 USC 3720 Name of Law: Collection of payments
   US Code: 31 USC 3720A Name of Law: Reduction of tax refund by amount of debt
   US Code: 37 USC 1007 Name of Law: Deductions from pay
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 42059	06/28/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 65463	09/22/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Authorization to Disclose Information Related To Stored Value Account	FS Form 5752	Authorization to Disclose Information Related to Stored Value Account
Application Form for U.S. Department of the Treasury Stored Value Card (SVC)	FS Form 2887	Application Form for U.S. Department of the Treasury Stored Value Card (SVC)

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	60,030	60,000	0	30	0	0
Annual Time Burden (Hours)	10,001	10,000	0	1	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The program changes represent the addition of FS Form 5752: Authorization to Disclose Information Related to Stored Value Account, a new instrument required to authorize disclosure of related SVC account information. The addition of the new form represents a total increase of thirty minutes for an adjustment in agency estimate for a total of 10,001 burden hours requested.

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Annual Cost to Federal Government: $45,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/22/2016

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