FS Form 2887 - Application Form for U.S. Department of the Treasury Stored Value Card (SVC) Program

Forms and Documents

Document Name	Status
Form FS Form 5752 Authorization to Disclose Information Related To Stored Value Account Form and Instruction	Unchanged
Form FS Form 2887 Application Form for U.S. Department of the Treasury Stored Value Card (SVC) Form and Instruction	Modified
1530-0013 Supporting Statement 2019.docx Supporting Statement A	2019-12-31

IC Document Collections

IC ID	Document Title	Status
223474	Authorization to Disclose Information Related To Stored Value Account Form and Instruction	Unchanged
207481	Application Form for U.S. Department of the Treasury Stored Value Card (SVC) Form and Instruction	Modified

ICR Details

OMB Control No: 1530-0013	ICR Reference No: 201911-1530-001
Status: Active	Previous ICR Reference No: 201609-1530-001
Agency/Subagency: TREAS/FISCAL	Agency Tracking No:
Title: FS Form 2887 - Application Form for U.S. Department of the Treasury Stored Value Card (SVC) Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/12/2020
	Date Received in OIRA: 12/31/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2023	36 Months From Approved	06/30/2020
Responses	102,030	0	60,030
Time Burden (Hours)	17,001	0	10,001
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of forms is used to collect information from individuals requesting enrollment in the Treasury SVC program along with supplemental information for contractors choosing to participate in the program, to obtain authorization to initiate debit and credit entries to their bank or credit union accounts, and to facilitate collection of any delinquent amounts. Disclosure of the information requested on the forms is voluntary; however, failure to furnish the requested information may significantly delay or prevent participation in the Treasury SVC program.

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Authorizing Statute(s): PL: Pub.L. 104 - 134 et al. Name of Law: Debt Collection Improvement Act of 1996
   US Code: 31 USC 1322 Name of Law: Payments of unclaimed trust fund amounts and refund of amounts erroneously deposited
   US Code: 5 USC 5514 Name of Law: Installment deduction for indebtedness to the United States
   US Code: 31 USC 3720 Name of Law: Collection of payments
   US Code: 31 USC 3720A Name of Law: Reduction of tax refund by amount of debt
   US Code: 37 USC 1007 Name of Law: Deductions from pay
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 31141	06/28/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 72140	12/30/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Authorization to Disclose Information Related To Stored Value Account	FS Form 5752	Authorization to Disclose Information Related to Stored Value Account
Application Form for U.S. Department of the Treasury Stored Value Card (SVC)	FS Form 2887, FS Form 2889	Application Form for U.S. Department of the Treasury Stored Value Card (SVC) ,   U.S. Department of the Treasury Stored Value Card Contractor Agreement

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ICR Summary 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	102,030	60,030	0	42,000	0	0
Annual Time Burden (Hours)	17,001	10,001	0	7,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Enrolling contractors in the Treasury SVC program is estimated to increase use of FS Form 2887 by 35% resulting in an additional 21,000 respondents. Those same 21,000 respondents will be required to complete a new supplemental form, FS Form 2889: U.S. Department of the Treasury Stored Value Card Contractor Agreement. The additional respondents and addition of the supplemental form represents a total increase of 42,000 responses and 7,000 hours for an adjustment in agency estimate for a total of 17,001burden hours requested.

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Annual Cost to Federal Government: $45,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/31/2019

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