A. Justification for: FS Form 5394, " Agreement And Request For Disposition Of A Decedent’s Treasury Securities.”
Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection.
The information is necessary to distribute Treasury securities and/or payments to the entitled person(s) when the decedent’s estate was formally administered through the court and has been closed, or the estate is being settled in accordance with State statute without the necessity of the court appointing a legal representative.
Indicate how, by whom, and for what purpose the information is to be used.
The information on the completed form is used by the Department of the Treasury, Bureau of the Fiscal Service to identify the securities involved in the decedent’s estate and to establish a claim for person’s entitled to collect payments and/or transfer securities. Without the information, the transaction cannot be completed.
Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology. What consideration is given to use information technology to reduce burden?
The form is available from the Bureau of the Fiscal Service and also on the Internet as a fill-in PDF form.
Describe efforts to identify duplication. Why can’t any similar information already available be used or modified for use for the purposes described in item 2 above?
No similar information is on file because the collection of information is made only for a specific purpose.
If the collection of information impacts small business or other small entities describe any methods used to minimize burden?
This collection of information does not impact small business or other small entities.
What consequences to Federal program or policy activities and what, if any, technical or legal obstacles to reducing burden will occur if this collection is not conducted or is conducted less frequently?
The collection of information cannot be conducted less frequently because the collection is initiated for a single purpose.
Is this collection of information conducted in a manner consistent with the guidelines of 5 CFR 1320.6?
The collection of information cannot be conducted less frequently because the collection is initiated for a single purpose.
What effort was made to notify the general public about this collection of information?
The Bureau’s notice was published in the Federal Register on October 7, 2016, Page 69902. No comments were received.
What decision was made to provide any payment or gift to respondents, other than reenumeration of contractors or grantees? There are no payments or gifts made to respondents.
What assurance of confidentiality was provided to respondents and what was the basis for the assurance in statute, regulations, or agency policy?
Aside from protections contained in the Privacy Act, there is no guarantee of confidentiality.
What justification is there for questions of a sensitive nature?
There are no questions of a sensitive nature. Personally identifiable information(PII) collected on this form such as name and social security number is necessary to establish entitlement and request proper distribution of United States Treasury Securities and/or related payments. An applicable System of Records Notice for this information was published August 17, 2011. System of Records Name: Treasury/BPD.002 – United States Savings-Type Securities.
What is the estimated hour burden of this collection of information? The average time needed is 30 minutes per response multiplied by the estimated number of responses (18,500) reflects the total burden of 9,250 hours.
What is the estimated total annual cost burden to respondents or recordkeepers resulting from this collection of information? Estimated cost burden to respondents is not available.
What is the annualized cost to the Federal Government?
The following factors were used to estimate the annual burden to this agency:
Printing cost - estimated number of forms printed annually, multiplied by the unit cost of the forms.
Case processing cost – estimated number of forms completed, multiplied by a percentage of the unit cost of case processing.
Forms management cost - salary cost of forms management personnel.
Printing Cost |
18,500 |
$0.02/form |
$370.00 |
Case Processing Cost |
18,500 |
1.50/form |
$27,750.00 |
Forms Management Cost |
|
|
$500.00 |
Total Cost |
|
|
$28,620.00 |
What is the reason for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-I?
No changes or adjustments are reported.
For collections of information whose results will be published, outline plans for tabulation and publication.
The results of the collection of this information will not be published for statistical use.
If seeking approval to not display the expiration date for OMB approval of this information collection, what are the reasons that the display would be inappropriate?
The public interest will be better served by not displaying an expiration date on FS Form 5394. The time period during which the current edition of the form will continue to be usable cannot be predicted. It could easily span several cycles of review and OMB clearance renewal. Displaying the expiration date would make it necessary to update the electronic form and website where it is accessed after each renewal. Additionally, not displaying the expiration date on the form will avoid confusion among members of the public who may have identical forms with different expiration dates in their possession. By not displaying the expiration date, supplies of the form could continue to be used regardless of when the OMB approval has expired. This would reduce costs incurred through additional printing and desktop publishing.
What are the exceptions to the certification statement?
There are no exceptions to the certification statement.
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT |
| Author | bmetz |
| Last Modified By | Bruce Sharp |
| File Modified | 2016-12-12 |
| File Created | 2016-12-12 |