Information Collection

Claim Against the United States for the Proceeds of a Government Check

IC 15380 under ICR 202109-1530-004 · OMB 1530-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1530-0010 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FMS 1133 Claim Against the United States for the Proceeds of a Government Check	Form and Instruction
FMS 1133 Claim Against the United States for the Proceeds of a Go FS1133 5.26.21.pdf	Form and Instruction
FMS 1133 Claim Against the United States for the Proceeds of a Go FS1133 5.26.21.pdf	Form and Instruction
FS Form 1133-A Claim Against the United States for Proceeds of a Govern Blank BFS 1133a.pdf	Form and Instruction
FS Form 1133-A Claim Against the United States for Proceeds of a Govern Blank BFS 1133a.pdf	Form and Instruction

IC Title:

Claim Against the United States for the Proceeds of a Government Check

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	FMS 1133	Claim Against the United States for the Proceeds of a Government Check	FS1133 5.26.21.pdf		Yes	No	Printable Only
Form and Instruction	FS Form 1133-A	Claim Against the United States for Proceeds of a Government Check (SSA)	Blank BFS 1133a.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title: Treasury/FMS .002 Payment Records

FR Citation: 77 FR 62602

Number of Respondents: 51,640

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	51,640	51,640
Annual IC Time Burden (Hours)	8,609	8,609
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.