Information Collection Request

Financial Institution Data Match / Federally Assisted State Transmitted Levy

ICR 201706-0970-006 · OMB 0970-0196 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 FAST Levy Record Specs Form Removed Available
Form 1 FAST Levy Record Specs Form and Instruction Modified Available
Form 1 MSFIDM Record Specs. Form and Instruction Removed Available
Form 1 MSFIDM Record Specs Form and Instruction Modified Available
Form 1 MSFIDM Election Form and Instructions Form and Instruction Modified Available
2017_06_23_MSFIDM_FAST_Levy_Supporting_Statement.doc Supporting Statement A Uploaded 2017-07-06 Available
Request for Non substantive Changes 10-14.docx Justification for No Material/Nonsubstantive Change Uploaded 2014-10-29 Available
0970-0196_MSFIDM_Record Specs.docx Supplementary Document Uploaded 2014-09-26 Available
0970-0196_PRA_MSFIDM_Election_Form.docx Supplementary Document Uploaded 2014-09-26 Available
Revised abstract for 0970-0196.docx Supplementary Document Uploaded 2014-09-26 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
227400 FAST Levy Response Withhold Record Specifications: Financial Institutions Other-specification New
227399 FAST Levy Record Specifications: Current State Child Support Agencies to Program New Codes Other-specification New
227397 FAST Levy Record Specifications: Current Financial Institutions Users to Program New Codes Other-specification New
211685 FAST Levy Response Withhold Record Specifications: Multistate Financial Institutions Form RemovedFAST Levy Record Specs
211684 FAST Levy Response Withhold Record Specifications: State CSE Form and Instruction ModifiedFAST Levy Record Specs
197583 Financial Data Match Result File - Automated Form and Instruction RemovedMSFIDM Record Specs.
182145 Financial Data Match Result File Form and Instruction ModifiedMSFIDM Record Specs
10015 Election Form Form and Instruction ModifiedMSFIDM Election Form and Instructions

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2020 36 Months From Approved 09/30/2017
805 0 673
5,275 0 3,974
673 0 482,799





table that charts list 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 805 673 0 132 0 0
Annual Time Burden (Hours) 5,275 3,974 0 1,301 0 0
Annual Cost Burden (Dollars) 673 482,799 0 -482,126 0 0


Reginfo record details
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