EFT Waiver Form - DFAS

Request for Payment of Federal Benefit by Check, EFT Waiver Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1530-0019 can be found here:

Documents and Forms

Document Name Document Type
Form FS Form 1201W-DFAS EFT Waiver Form - DFAS Form and Instruction
FS Form 1201W-DFAS Request for Payment by Federal Benefits Check FS_Form_1201WDFAS.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	EFT Waiver Form - DFAS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

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	FS Form 1201W-DFAS	Request for Payment by Federal Benefits Check	FS_Form_1201WDFAS.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title: Direct Deposit Enrollment Records-Treasury/FMS .006	FR Citation: 76 FR 42765

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	123	123

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.