Information Collection

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

IC 15380 under ICR 202411-1530-004 · OMB 1530-0010.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FS 1133 Claim Against the United States for the Proceeds of a Government Check	Form and Instruction
Form FS 1133 Claim Against the United States for the Proceeds of a Government Check Claim Against the United States for the Proceeds of a Government Check	Form and Instruction
FS 1133 Claim Against the United States for the Proceeds of a Go FS 1133.pdf	Form and Instruction
FS 1133 Claim Against the United States for the Proceeds of a Go FS 1133.pdf	Form and Instruction

IC Title:

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	FS 1133				Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title: Treasury/Fiscal Service .002 Payment Records

FR Citation: 85 FR 11776

Number of Respondents: 81,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	81,000	29,360	51,640
Annual IC Time Burden (Hours)	13,500	4,891	8,609
Annual IC Cost Burden (Dollars)	0	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].