Information Collection

Electronic Transfer of Funds (EFT) Authorization

IC 214935 under ICR 202610-0906-006 · OMB 0906-0081.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 33 Electronic Funds Transfer (EFT) Authorization.pdf Electronic Transfer of Funds (EFT) Authorization	Form and Instruction
33 Electronic Funds Transfer (EFT) Authorization.pdf Electronic Transfer of Funds (EFT) Authorization.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	33				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: System of Record Notice 09-15-0054

FR Citation: 88 FR 17854

Number of Respondents: 632

Number of Respondents for Small Entity: 9

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	632	-102	734
Annual IC Time Burden (Hours)	51	-8	59
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.

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