Financial Data Match Result File

Financial Institution Data Match / Federally Assisted State Transmitted Levy

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0196 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Financial Data Match Result File Form and Instruction
1 MSFIDM Record Specs 0970-0196_MSFIDM_Record Specs.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Financial Data Match Result File	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	MSFIDM Record Specs	0970-0196_MSFIDM_Record Specs.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 192	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	768	320	448
Annual IC Time Burden (Hours)	64	-84	148
Annual IC Cost Burden (Dollars)	0	-190,058	190,058

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.