Request for Recurring Electronic Payments

Accounts Receivable Forms for Debt Repayment

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.