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Election Form
Multistate Financial Institution Data Match and Federally Assisted State Transmitted Levy (MSFIDM/FAST Levy)
OMB: 0970-0196
IC ID: 10015
OMB.report
HHS/ACF
OMB 0970-0196
ICR 202311-0970-004
IC 10015
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0196 can be found here:
2024-03-22 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
Election Form
Form and Instruction
1 MSFIDM Election Form
0970-0916_MSFIDM Election Form_092023.docx
Form and Instruction
Information Collection (IC) Details
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