CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A GOVERNMENT CHECK

ICR 198109-1510-004

OMB: 1510-0024

Federal Form Document

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Name
Status
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ICR Details
1510-0024 198109-1510-004
Historical Active
TREAS/FMS
CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A GOVERNMENT CHECK
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 10/22/1981
Retrieve Notice of Action (NOA) 09/11/1981
  Inventory as of this Action Requested Previously Approved
12/31/1983 12/31/1983
1,967 0 0
98 0 0
0 0 0

THE FORM IS USED TO TRANSMIT INCOMPLETE CLAIM FORMS BACK TO PAYEE THAT HAS REQUESTED PAYMENT FOR A LOST, STOLEN OR MUTILATED U.S. GOVERNMENT CHECK. ANY UNANSWERED QUESTIONS WILL REQUIRE THAT THE CLAIM BE RETURNED FOR COMPLETION.

None
None


No

1
IC Title Form No. Form Name
CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A GOVERNMENT CHECK TFS 1503

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,967 0 0 0 1,967 0
Annual Time Burden (Hours) 98 0 0 0 98 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/11/1981


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