1. Explain the circumstances that make this collection of information necessary. Identify any legal or administrative requirements that necessitate the collection.
This information is collected by authority of 31 U.S.C. 3102, et seq. The information is collected from unpaid creditors to request payment of United States Securities and/or related payments belonging to a decedent’s estate that is not being administered.
2. Indicate how, by whom and for what purpose is this information used?
The information on the completed form is used by the Department of the Treasury, Bureau of the Fiscal Service to identify the securities associated with the decedent’s estate, and then determine a creditor’s entitlement. Without the information, the Bureau could create a potential legal liability to the United States Government by incorrectly disposing of securities or related checks.
3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology? What consideration is given to use information technology to reduce burden?
The forms in this collection are available in electronic format. Users can download the form from the Fiscal Service website and complete it on their own, or a Customer Service Representative may complete all or part of the form for the registered owner and send it for confirmation.
4. Describe efforts are used to identity duplication? Why can’t any similar information already available be used or modified for use for the purposes described in Item 2 above?
The information on the form is collected for a single purpose as described in Item 2 above. No other federal governmental agency collects this type of information, therefore, no duplication exists.
5. If this collection of information impacts small businesses or other small entities, what methods are used to minimize burden?
This collection of information does not impact small business or other small entities.
6. What consequences to Federal program or policy activities and what, if any, technical or legal obstacles to reducing burden will occur if this collection is not conducted or is conducted less frequently?
Information requested on the form is voluntary, however, without the use of the form, the Bureau of the Fiscal Service and its agents would not have the ability to issue securities, process transactions, make payments, and identify owners and their accounts.
7. Is this collection of information conducted in a manner consistent with the guidelines of 5 CFR 1320.6?
The collection of information cannot be conducted less frequently because the collection is initiated for a single purpose.
8. What effort was made to notify the general public about this collection of information?
The Bureau’s notice was published in the Federal Register on December 16, 2021, Volume 86, Page 71546. No comments were received.
9. What decision was made to provide any payment or gift to respondents, other than reenumeration of contractors or grantees?
There are no payments or gifts made to respondents.
10. What assurance of confidentiality was provided to respondents and what was the basis for the assurance in statute, regulations, or agency policy?
Aside from protections contained in the Privacy Act, there is no guarantee of confidentiality.
11. What justification is there for questions of a sensitive nature?
There are no questions of a sensitive nature. Personally identifiable information (PII) collected on this form such as name and social security number is necessary to establish entitlement and request proper distribution of United States Treasury Securities and/or related payments. An applicable System of Records Notice for this information was published February 27, 2020. System of Records Name: Treasury/Fiscal Service .014—United States Securities and Access) and Treasury/ Fiscal Service .020– U.S. Treasury Securities Fraud Information Systems. The privacy impact assessment (PIA) conducted for this collection of information can be found at https://www.fiscal.treasury.gov/files/pia/sabre-pclia.pdf
12. What is the estimated hour burden of this collection of information?
The average time needed is 6 minutes per response multiplied by the estimated number of responses (2,200) reflects the total burden of 220 hours.
Estimate of Burden Hours.
Form |
# Respondents |
Responses per Respondent |
Annual Responses |
Time per Response |
Total Burden |
FS Form 1050 |
2,200 |
1 |
2,200 |
0.1 |
220 |
Estimate of Annual Respondent Cost.
Form |
No. of Respondents |
Number of Responses per Respondent |
Average Burden per Response (in hours) |
Total Annual Burden (in hours) |
Average Hourly Wage Rate1 |
Total Annual Respondent Cost |
1050 |
2,200 |
1 |
6 minutes (0.1 hours) |
220 |
$38.98 |
$8,575.60 |
Total Respondent Cost: |
$8,575.60 |
|||||
13. What is the estimated total annual cost burden to respondents or recordkeepers resulting from this collection of information?
There are no capital/start-up or ongoing operation/maintenance costs associated with this information collection.
14. What is the annualized cost to the Federal Government?
In general, Fiscal Service has determined that there are no annualized non-labor, printing, or distribution costs to the Government associated with this information collection. Fiscal Service processes this collection to verify the validity of the transaction requested by the owner and to maintain a record of the request. In addition, there are no printing and distribution costs associated with this collection as it is available on the Fiscal Service website in electronic form.
As for Federal Government labor costs, Fiscal Service has determined that its labor costs for this information collection are limited to analyzing incoming correspondence concerning Treasury securities and securities transactions requests. Therefore, Treasury estimates its labor costs for paper submissions of this collection as follows:
Labor Category |
Fully-loaded Labor Rate/Hour2 |
Avg. Processing Time per Response |
Labor Costs per Response |
Total Responses |
Total Govt. Labor Costs |
Customer Service Specialist (GS–11 Step 5 for the locality pay area of Rest of U.S.) |
$38.66 |
35 minutes |
$22.55 |
2,200 |
$49,610.00 |
Federal Government Fully-loaded Labor Rate per Hour = Wage rate x a factor of 1.63 to account for benefit costs. Per the Office of Personnel Management (OPM) wage data, the hourly fully-loaded labor rate for a GS–11, step 5 Federal employee in the Parkersburg, WV (RUS) wage area is $58.61 ($35.96 wages plus $22.65 in benefit costs). See the OPM website at https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/22Tables/pdf/RUS_h.pdf
15. What is the reason for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-I?
There is an increase in burden based on updated data on the number of forms being filed annually.
16. For collections of information whose results will be published, outline plans for tabulation and publication.
The results of the collection of this information will not be published for statistical use.
17. If seeking approval to not display the expiration date for OMB approval of this information collection, what are the reasons that the display would be inappropriate?
The public interest will be better served by not displaying an expiration date on Form FS Form 1050. The time period during which the current edition of the form will continue to be usable cannot be predicted. It could easily span several cycles of review and OMB clearance renewal. Displaying the expiration date would make it necessary to update the electronic form and website where it is accessed after each renewal. Additionally, not displaying the expiration date on the form will avoid confusion among members of the public who may have identical forms with different expiration dates in their possession. By not displaying the expiration date, supplies of the form could continue to be used regardless of when the OMB approval has expired. This would reduce costs incurred through additional printing and desktop publishing.
18. What are the exceptions to the certification statement?
There are no exceptions to the certification statement.
B. This collection does not employ statistical methods.
1 It is expected that respondents to this collection could be from any occupation. The average wage rate for all occupations is $ $27.07 according to the May 2020 National Occupational Employment and Wage Estimates. https://www.bls.gov/oes/current/oes_nat.htm A benefit multiplier of 1.44 is used to calculate a fully-loaded wage rate of $27.07*1.44=$38.98
Using the BLS Employer Costs for Employee Compensation – March 2020 report https://www.bls.gov/news.release/pdf/ecec.pdf, a benefit multiplier of 1.44 was calculated by taking the private industry worker 50th (median) wage percentile total compensation rate divided by the wages and salaries rate. $26/$18.05=1.44
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | ATF |
| File Modified | 0000-00-00 |
| File Created | 2022-05-02 |