Election Form

Multistate Financial Institution Data Match and Federally Assisted State Transmitted Levy (MSFIDM/FAST Levy)

OMB: 0970-0196

IC ID: 10015

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Election Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 MSFIDM Election Form 0970-0196_MSFIDM_Election_Form.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

15 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 15 0 -15 0 0 30
Annual IC Time Burden (Hours) 8 0 -7 0 0 15
Annual IC Cost Burden (Dollars) 0 0 -673 0 0 673

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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