Information Collection

Treasury Direct Forms

IC 16570 under ICR 202008-1530-002 · OMB 1530-0042.

⚠️ Notice: This information collection may be referencing outdated material.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

2024-01-31 - Extension without change of a currently approved collection

Documents and Forms

Document Name Document Type
Form FS Form 5236 Treasury Direct Forms Form and Instruction
FS Form 5178 Transaction Request sec5178.pdf www.treasurydirect.gov/forms/sec5178.pdf 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 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 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 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 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
FS Form 5236 Claim for Proceeds of a Check FSF5236.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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:

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

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title: Treasury/Fiscal Service.013 â United States Securities and Access	FR Citation: 85 FR 11776

Number of Respondents: 5,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,100	-15,800	20,900
Annual IC Time Burden (Hours)	1,105	-3,423	4,528
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.