FAST Levy Response Withhold Record Specifications: State CSE

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⚠️ Notice: This information collection may be referencing outdated material.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 FAST Levy Response Withhold Record Specifications: State CSE Form and Instruction
1 FAST Levy Record Specs 0970-0196 FAST_Levy_Record Specifications.docx Form and Instruction

Information Collection (IC) Details

IC Title:	FAST Levy Response Withhold Record Specifications: State CSE	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 303.7

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	FAST Levy Record Specs	0970-0196 FAST_Levy_Record Specifications.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: 2	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2	-5	7
Annual IC Time Burden (Hours)	3,220	997	2,223
Annual IC Cost Burden (Dollars)	0	0	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.