Information Collection

Treasury Direct Forms

IC 16570 under ICR 201706-1530-001 · OMB 1530-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1530-0042 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FS Form 5178 Treasury Direct Forms	Form and Instruction
FS Form 5178 Transaction Request sec5178.pdf www.treasurydirect.gov/forms/sec5178.pdf	Form and Instruction
FS Form 5179 Security Transfer Request sec5179.pdf www.treasurydirect.gov/forms/sec5179.pdf	Form and Instruction
FS Form 5188 Durable Power of Attorney for Securities and Savings Bon sav5188.pdf www.treasurydirect.gov/forms/sav5188.pdf	Form and Instruction
FS Form 5191 Application for Recognition as a Natural Guardian of a M sec5191.pdf www.treasurydirect.gov/forms/sec5191.pdf	Form and Instruction
FS Form 5235 Report of Non-Receipt, Loss, Theft, or Destruction of a sec5235.pdf www.treasurydirect.gov/forms/sec5235.pdf	Form and Instruction
FS Form 5236 Claim for Proceeds of a Check FSF5236.pdf	Form and Instruction

IC Title:

Treasury Direct Forms

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FS Form 5178	Transaction Request	sec5178.pdf	https://www.treasurydirect.gov/forms/sec5178.pdf	Yes	No	Fillable Printable
Form and Instruction	FS Form 5179	Security Transfer Request	sec5179.pdf	https://www.treasurydirect.gov/forms/sec5179.pdf	Yes	No	Fillable Printable
Form and Instruction	FS Form 5188	Durable Power of Attorney for Securities and Savings Bonds Transactions	sav5188.pdf	https://www.treasurydirect.gov/forms/sav5188.pdf	Yes	No	Fillable Printable
Form and Instruction	FS Form 5191	Application for Recognition as a Natural Guardian of a Minor	sec5191.pdf	https://www.treasurydirect.gov/forms/sec5191.pdf	Yes	No	Fillable Printable
Form and Instruction	FS Form 5235	Report of Non-Receipt, Loss, Theft, or Destruction of a Fiscal Agency Check and Application for Replacement	sec5235.pdf	https://www.treasurydirect.gov/forms/sec5235.pdf	Yes	No	Fillable Printable
Form and Instruction	FS Form 5236	Claim for Proceeds of a Check	FSF5236.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title: Treasury/BPD.002 - United States Savings-Type Securities

FR Citation: 76 FR 51128

Number of Respondents: 20,900

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	20,900	20,900
Annual IC Time Burden (Hours)	4,528	4,528
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.