Information Collection

Request for Recurring Electronic Payments

IC 255632 under ICR 202208-1530-001 · OMB 1530-0075.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1530-0075 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FS Form 00122 Request for Recurring Electronic Payments	Form and Instruction
FS Form 00122 Request for Recurring Electronic Payments Request for Recurring Electronic Payments.pdf	Form and Instruction
FS Form 00122 Request for Recurring Electronic Payments Request for Recurring Electronic Payments.pdf	Form and Instruction

IC Title:

Request for Recurring Electronic Payments

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	FS Form 00122	Request for Recurring Electronic Payments	Request for Recurring Electronic Payments.pdf		Yes	No	Fillable Fileable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	87	87

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.