0970-0196 ICRASJr 2-23-11

0970-0196 ICRASJr 2-23-11.xls

Financial Institution Data Match

0970-0196 ICRASJr 2-23-11

OMB: 0970-0196

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0970-0196 can be found here:

Document [xlsx]

Download: xlsx | pdf

Overview

Template Summary
Part1 Form - ICR
Part2 Form - IC
Part2 Form - IC (2)
Part2 Form - IC (3)
Part2 Form - IC (4)
Part2 Form - IC (5)
Part2 Form - IC (6)
Part2 Form - IC (7)
Part2 Form - IC (8)
Part2 Form - IC (9)
Part2 Form - IC (10)

Sheet 1: Template Summary



			*Template System*






Part 1 Form (ICR):
View / Edit Part 1 Form (ICR)

Part 2 Forms (IC):
1	View / Edit [Financial Data Match Result File (CD Rom Transmission)]
2	View / Edit [Election Form]
3	View / Edit [Financial Data Match Result File (Electronic Transmitters)]
4	View / Edit []
5	View / Edit []
6	View / Edit []
7	View / Edit []
8	View / Edit []
9	View / Edit []
10	View / Edit []

Summary of IC/Part 2 Burden:

				Change Due to
		Total Requested	New Statute	Agency Discretion	Adjustment in Agency Estimate	Violation	Currently Approved
Annual Responses		1,362	0	1,362	0	0	0
Annual Hour Burden		493	0	493	0	0	0
Annual Cost Burden		$424,519	0	424,519	0	0	0

Sheet 2: Part1 Form - ICR

Use the "Validate Form" checkbox as a guide before exporting an xml. Highlighted fields and text indicate suggested information to include before uploading into ICRAS.

View / Edit Part 2 - [Financial Data Match Result File (CD Rom Transmission)]

Go to Template Summary

Enter the name of the agency/subagency submitting the request

1. Agency/Subagency originating request

OCSE

Enter the existing eight-digit OMB control Number or the first 4 digits of the Operating Division - New (example 0970-New)

4. OMB Control or reference #

0970-0196

Provide the official title of the information collection request

2. Title

Financial Institution Data Matc

a. Select "New collection" when the collection has not previously been used or sponsored by the agency. b. Select "Revision" when the collection is currently approved by OMB, and the agency request includes a material change to the collection instrument, instructions, its frequency of collection, or the use to which the information is to be put. c. Select "Extension" when the collection is currently approved by OMB, and the agency wishes only to extend the approval past the current expiration date without making any material change in the collection instrument, instructions, frequency of collection, or the use to which the information is to be put. d. Select "Reinstatement without change" when the collection previously had OMB approval, but the approval has expired or was withdrawn before this submission was made, and there is no change to the collection. e. Select "Reinstatement with change" when the collection previously had OMB approval, but the approval has expired or was withdrawn before this submission was made, and there is change to the collection. f. Select "Existing collection in use without OMB control number" when the collection is currently in use but does not have a currently valid OMB control number. g. Select "Nonmaterial/Nonsubstantive Change to perform the function of the former 83C Change Sheet". (submit your explanation of the requested change along with the template.)

3. Type of Request

a. Select "Regular" when the collection is submitted under 5 CFR 1320.10, 1320.11, or 1320.12 with a standard 60 day review schedule. b. Select "Emergency" when the agency is submitting the request under 5 CFR 1320.13 for emergency processing and provides the required supporting material. Provide the date by which the agency requests approval and the justification in the blank presented upon selection of "Emergency". c. Select "Delegated" when the agency is submitting the collection under the conditions OMB has granted the agency delegated authority.

5. Type of Review Requested:

a. Select "Three years" if the agency requests a three year approval for the collection. b. Select "6 months from approval date" (maximum for emergencies) for a 6 month extension. c. Select "Other" if the agency requests approval for less than three years. Specify the month and year of the requested expiration date or how many months from the approval date.

6. Requested Expiration Date:

(if Emergency, enter justification – 4000 characters max)

Specify date:

*OR* Number of Months from Approval Date:

Provide a statement, limited to 4,000 characters of text, covering the agency's need for the information, uses to which it will be put, and a brief description of the respondents. The requirement to identify Keywords has been removed as a requirement because the text search of titles and abstracts are possible. You may want to continue to include in titles and abstracts keywords (descriptors) from the "Federal Register Thesaurus of Indexing Terms" that describe the subject area(s) of the information collection. The link for the Federal Register Thesaurus (http://www.archives.gov/federalregister/cfr/thesaurus.html)

7. Abstract: (4000 characters maximum)

Section 466(a)(17) of the Social Security Act (the Act), requires that states establish procedures under which the state child support enforcement (CSE) agency shall enter into agreements with financial institutions doing business in the state for the purpose of securing information leading to the enforcement of child support orders. The state operates, in coordination with financial institutions, and the Federal Parent Locator Service (FPLS) in the case of financial institutions doing business in multiple states, a data match system.

Provide the statute(s) that is the source of the ICR or the source of the associated rulemaking, whichever is more appropriate. If neither is appropriate, provide the authorizing statute for the program or for the agency or leave blank. Citation information may be entered for the Public Law, US Code, Executive Order, or Statute.

8. Authorizing Statute(s):

Title

Section

Name

N/A

US Code

666(a)(17)

Financial Institution Data Match

Congress No.

Sequence No.

Section

Name

Public Law

Title

Section

Name

N/A

US Code

Title

Section

Name

N/A

US Code

Select Proposed Rule or Interim Final or Final Rule, as appropriate or leave the section blank if it the collection is not associated with rulemaking. If Proposed rule or Interim Final Rule, enter the RIN (Regulation Identifier Number), the Federal Register Citation and the Citation Date. For a Proposed Rule, OMB will not consider an ICR complete until the Notice of Proposed Rulemaking has been published. You do not need to attach the rule unless it has not been published (i.e., Federal Register information is blank). If this is the case, send the appropriate stage of rulemaking and send the draft rule. For ICRs associated with Interim Final rules that are not significant under EO 12866, please send a draft of the Federal Register notice as an attachment.

9. Associated Rulemaking Information:

RIN:

(eg: 9999-XX99)

Stage of rulemaking

Federal Register Citation:

Volume:

Page No:

Publication Date:

For a Proposed Rule, OMB will not consider an ICR complete until the Notice of Proposed Rulemaking has been published.

For a Final Rule, please put the ICR reference number for the ICR reviewed at the proposed rule stage in Box 4.

For ICRs associated with Interim Final or Final rules that are not significant under EO

Enter the Federal Register Citations and Citation Dates of the 60- and 30-day notices for the ICR. You no longer need to provide a copy of the FR notice. However, if you wish to provide a draft Federal Register notice, for a request for an Emergency ICR, for instance, send the document. Unless submitted as an Emergency or Associated with Rulemaking, OMB will not consider an ICR complete without the 30-day notice publication citation.

10. Federal Register Notices and Comments:

60 day notice

Volume:

Page No:

45632

Publication Date:

8/3/2010

30 day notice

Volume:

Page No:

Publication Date:

Public comments can be, but are not required to be, sent to OMB, especially if the comments are available through the Federal Docket Management System or other electronic means that can be made available to the OIRA desk officer. Comments received by OIRA in response to the 30-day notice will be uploaded by OIRA. When providing multiple comments, it is adequate to provide a representative comment document.

Did the Agency receive public comments on this ICR?

Provide estimated annualized cost to the Federal government, if any, of implementing the collection. In the Supporting Statement A, provide a description of the method used to estimate cost, which should include quantification of hours, operational expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information.

11. Annual Cost to the Federal Government:

$207,000

Select "Yes" if the information collection uses statistical methods such as sampling or imputation. Generally, select "No" for applications and audits (unless a random auditing scheme is used). Select "Yes" for statistical collections, most research collections, and program evaluations using scientific methods. For other types of data collection, the use of sampling, imputation, or other statistical estimation techniques should dictate the response for this item. Ensure that supporting documentation is provided in Supporting Statement B.

12. Does this ICR contain surveys, censuses, or employ statistical methods?

Select "Yes" or "No"

13. Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?

Enter the name of the agency person best able to answer questions regarding the content of this submission. If sensitive to having this name published on the OMB website, http://www.whitehouse.gov/omb/inforeg/infocoll.html or www.RegInfo.gov, please consider using the name of the agency's Clearance Officer.

14. Agency Contact:

First Name

Last Name

Phone

Primary Contact (Will be sent to OMB):

Jean

Shaw

202-260-2977

jean.shaw@acf.hhs.gov

Secondary Contact:

Matt

Marsolais

202-260-5479

matthew.marsolais@acf.hhs.gov

15. ICR Summary of Burden:

Information Collection Budget (ICB)

Identify the citation(s) for New Statutory Requirements, if a change in burden is due to a Program Change due to New Statute. You may enter one or more citations for Public Law, Executive Order, US Code, or Statute.

If a change in burden is due to a Program Change Due to New Statute, identify the Citations for New Statutory Requirements:

Congress No.

Sequence No.

Section

Name

Public Law

Congress No.

Sequence No.

Section

Name

Public Law

Congress No.

Sequence No.

Section

Name

Public Law

Congress No.

Sequence No.

Section

Name

Public Law

If Program Change is due to Agency Discretion, categorize the burden reduction from one of the options.

If Program Change is due to Agency Discretion, please categorize the reduction. Burden reduction from:

If Program Change is due to Agency Discretion, categorize the burden increase from one of the options.

If Program Change is due to Agency Discretion, please categorize the increase in burden. Burden increase caused by:

Enter reasons for any program changes or adjustments. Provide the rationale for the increase or decrease.

Explain the reasons for any program changes or adjustments reported; that is, provide a short statement how the reduction in burden

was achieved or why the increase in burden occurred. (If you need more space, please provide a short summary here and

elaborate in the Supporting Statement.)

Overall, the total number of burden hours has decreased from the last submission from 8425.5 to 402.88. OCSE determined that the 310 transmitters are submitting for all the financial institutions, with 259 transmitters returning data via Encrypted CD-ROM; and 51 return data electronically. It was determined that there are no burden hours associated with submitting the data electronically.

The number of respondents for the Election Form has increased because of an increase in the number of financial institutions participating in the data match. The increased number of financial institutions participating is due to an influx of multistate financial security firms opting to participate in the program. New financial institutions are required to fill out the Election Form one time, just prior to matching.

View / Edit Part 2 - [Financial Data Match Result File (CD Rom Transmission)]

Go to Template Summary

Sheet 3: Part2 Form - IC

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Title the IC (information collection) with potential text search in mind.

1. Title:

Financial Data Match Result File (CD Rom Transmission)

Select "Yes" to identify forms that your agency is willing to host for potential use by other agencies as well as your own. If your OIRA desk officer agrees, the form will become part of an inventory of common forms. When an agency selects a common form from the inventory, the using agency will be accountable for the burden of its use rather than the hosting agency.

2. Is this a Common Form?

Only one option can be selected. If more than one applies, a second Part 2 form will need to be completed. The "obligation to respond" is either mandatory, required to obtain benefits, or voluntary. Select the category that applies to the IC. If more than one category applies, you will need to create a second IC to account for the burden associated with all the categories that apply. a. Mark "Voluntary" when the response is entirely discretionary and has no direct effect on any benefit or privilege for the respondent. b. Mark "Required to obtain or retain benefits" when the response is elective, but is required to obtain or retain a benefit. c. Mark "Mandatory" when the respondent must reply or face civil or criminal sanctions.

3. Obligation to Respond

Many or no selections is acceptable.

4. Frequency of reporting (check all that apply)

An information collection is usually a form or survey, but can also be required by a statute or regulation. To identify regulation that is the requirement to collect the information, enter the regulation in the CFR Citation. Multiple citations can be entered for a single IC as long as one Affected Public, Obligation to Respond, and the Line of Business applies. Add multiple CFR citations as appropriate in the table provided.

5. CFR Citation(s) for the information collection under review (if applicable)

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

The "line of business" refers to the federal government's lines of business in services to citizens and management of governmental resources affecting citizens as defined by the Federal Enterprise Architecture Business Reference Model. For more information on the Business Reference Model see http://www.whitehouse.gov/omb/egov/documents/FEA_CRM_v20_Final_June_2006.pdf "The Business Reference Model" is a function-driven framework for describing the business operations of the federal government independent of the agencies that perform them. The Business Reference Model lines of business provide a way to identify government-wide common solutions for improved service to citizens. If an IT investment/system is related to the information collection, the line of business should be that which is used by the agency to justify the IT investment in its Exhibit 300. If there is no system, please use the definitions at http://www.whitehouse.gov/omb/egov/a-3-2-services.html to select the line of business that most accurately reflects the"business" of the collection. Because lines of business functionally cross organizations, assignment of lines of business to ICs will also enable identification of potential opportunities for merged and/or common forms and reduced burden. Select one option from the list. If more than one option applies, another Part 2 form will need to be completed.

7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)

Line of Business / Subfuction

Enter if applicable. If not, leave blank.

8. Privacy Act System of Records (if applicable)

Title:

Location and Collection System

FR Citation:

Title:

Page No.:

51446

Date:

9/7/2007

9. Number of Respondents

Only one option can be selected. If more than one applies, a second Part 2 form will need to be completed. Select the affected public from the list - individuals or households, private sector, state, local or tribal governments, or federal government. You may select one of the choices per IC. If you select private sector, you will need to select from another set of choices; i.e., private sector, farms, and not-for-profit institutions.

Affected Public

(if Private Sector

check all that apply)

This is the basis for a burden number that is calculated.

Total #

259

Indicate the number of respondents upon which the information collection will have a significant impact. A small entity may be (1) a small business which is deemed to be one that is independently owned and operated and that is not dominant in its field of operation; (2) a small organization that is any not-for-profit enterprise that is independently owned and operated and is not dominant in its field; or (3) a small government jurisdiction which is a government of a city, county, town, township, school district, or special district with a population of less than 50,000.

Small Entity #

Enter the estimated percentage of responses that will be submitted/collected electronically using electronic means, such as electronic mail, (mailed) diskette, or web-based transaction. Facsimile is not considered an electronic submission.

Percent Electronic

100

10. Frequency: How often on average will each respondent respond to the Information Collection?

Enter the Number of Responses per Respondent per Time Period by selecting from the list of frequency options. This will be used to calculate Annual Frequency and Annual Number of Responses based on your entries.

Number of Responses per Respondent

Per

Year

Calculated by multiplying the Number or Responses per respondent by the number of times they respond per year. Example - If the number of responses per respondent is 2 per month, the annual frequency would be 24 (2X12) Hour - 8736 per year Business Hour - 2080 per year Day - 365 per year Business Day - 260 per year Week - 52 per year Month - 12 per year Year - 1 per year Decade - .1 per year Quarterly - 4 per year Semi-annually - 2 per year Biennially -.5 per year

Calculated: Annual Frequency = 4 times a year (per respondent)

Calculated by multiplying the Annual Frequency (previous calculation) by the Total Number of Respondents. Use "Reporting" for information collections that involve reporting and select the frequency of reporting that is requested or required of a respondent. If the reporting is on "an event" basis, select "On occasion." Use "Recordkeeping" if the collection of information explicitly includes a recordkeeping requirement. Use "Third party disclosure" if a collection of information includes third-party disclosure requirements as defined by 1320.3(c). ** Do not report as a dollar cost any burden reported in hours. The supporting statement asks for this information, but it should not be reported here.

Calculated: Annual Number of Responses = 1036 a year

1036

Annual Hour Burden Enter the Time per Response for Reporting, Record keeping and/or Third party disclosure. Select the time period (hours, minutes, or seconds). Then calculate the Hour per Response. Use the conversion table below to do so. Hours 1 Minutes .01666 Seconds .00027 The Hour per Response will be the Time per Response times the conversion factor in the table. The Annual Hour Burden will be calculated by multiplying the Hour per Response by the Annual Number of Responses (see previous section). The total Annual Hour Burden will be the sum of all the Annual Hour Burdens for Reporting, Record keeping, and Third party disclosure. ** Notes regarding hour burden: Unless directed to do so, agencies should not conduct special surveys to obtain information on which to base hour burden estimates.Consultation with a sample (fewer than 10) of potential respondents is desirable. Generally, estimates should not include burden hours for customary and usual business practices. Annual Cost Burden To calculate the Annual Cost Burden enter the Cost per response for Reporting, Record keeping and/or Third party disclosure. The annual cost burden is the Cost per response for each selection times the Annual Number or Responses. The total Annual Hour Burden will be the sum of all the Annual Hour Burdens for Reporting, Record keeping, and Third party disclosure. Cost Burden includes: The annualized dollar cost for capital investment or start-up costs, such as, preparations for collecting information such as purchasing computers and software; monitoring, sampling, drilling and testing equipment; and record storage facilities.

11. Hour and Cost Burden

Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

Time Per Response

Hours Per Response

Annual Hour Burden

Reporting

0.33

Hours

0.33

341.88

Record Keeping

Hours

Third party disclosure

Hours

Total:

0.33

341.88

(Cost calculations should match the Supporting Statement Section A, question 13.)

Cost Per Response

Annual Cost Burden

Reporting

$344.44

$356,839.84

Record Keeping

$0.00

Third party disclosure

$0.00

Total:

$344.44

$356,839.84

Annual Responses (calculated above), Annual Hour Burden (calculated above), and/or the Annual Cost Burden (calculated above) are shown in the Total Requested Column. These totals are then broken out into the following three categories. Program Change due to Agency Discretion."Program change" is the result of deliberate Federal government action. The electronic system will assign all program changes to the Agency Discretion column unless specifically entered into another one of the columns. Program Change due to New Statute. All new collections and any subsequent revision of existing collections (e.g., the addition or deletion of questions) are recorded as program changes. Change Due to Adjustment in Agency Estimate. "Adjustment" is a change that is not the result of a deliberate Federal government action. Changes resulting from new estimates or action not controllable by the Federal government are recorded as adjustments. Change due to Violation of the PRA. This is a change as a result of a reinstatement due to expiration or a request for approval for collections not in adherence to the PRA, "bootleg collections".

12. Annual Responses and Burden

Change Due to

Total Requested

New Statute

Agency Discretion

Adjustment in Agency Estimate

Violation

Currently Approved

Annual Responses

1,036

Annual Hour Burden

342

Annual Cost Burden

$356,840

356,840

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Sheet 4: Part2 Form - IC (2)

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Title the IC (information collection) with potential text search in mind.

1. Title:

Election Form

2. Is this a Common Form?

3. Obligation to Respond

Many or no selections is acceptable.

4. Frequency of reporting (check all that apply)

5. CFR Citation(s) for the information collection under review (if applicable)

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)

Line of Business / Subfuction

Enter if applicable. If not, leave blank.

8. Privacy Act System of Records (if applicable)

Title:

Location and Collection System

FR Citation:

Title:

Page No.:

51446

Date:

9/7/2007

9. Number of Respondents

Affected Public

(if Private Sector

check all that apply)

This is the basis for a burden number that is calculated.

Total #

122

Small Entity #

Percent Electronic

10. Frequency: How often on average will each respondent respond to the Information Collection?

Number of Responses per Respondent

Per

Year

Calculated: Annual Frequency = 1 times a year (per respondent)

Calculated: Annual Number of Responses = 122 a year

122

11. Hour and Cost Burden

Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

Time Per Response

Hours Per Response

Annual Hour Burden

Reporting

0.5

Hours

0.5

Record Keeping

Hours

Third party disclosure

Hours

Total:

0.5

(Cost calculations should match the Supporting Statement Section A, question 13.)

Cost Per Response

Annual Cost Burden

Reporting

$21.00

$2,562.00

Record Keeping

$0.00

Third party disclosure

$0.00

Total:

$21.00

$2,562.00

12. Annual Responses and Burden

Change Due to

Total Requested

New Statute

Agency Discretion

Adjustment in Agency Estimate

Violation

Currently Approved

Annual Responses

122

Annual Hour Burden

Annual Cost Burden

$2,562

2,562

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Sheet 5: Part2 Form - IC (3)

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Title the IC (information collection) with potential text search in mind.

1. Title:

Financial Data Match Result File (Electronic Transmitters)

2. Is this a Common Form?

3. Obligation to Respond

Many or no selections is acceptable.

4. Frequency of reporting (check all that apply)

5. CFR Citation(s) for the information collection under review (if applicable)

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)

Line of Business / Subfuction

Enter if applicable. If not, leave blank.

8. Privacy Act System of Records (if applicable)

Title:

Location and Collection System

FR Citation:

Title:

Page No.:

Date:

9. Number of Respondents

Affected Public

(if Private Sector

check all that apply)

This is the basis for a burden number that is calculated.

Total #

Small Entity #

Percent Electronic

100

10. Frequency: How often on average will each respondent respond to the Information Collection?

Number of Responses per Respondent

Per

Year

Calculated: Annual Frequency = 4 times a year (per respondent)

Calculated: Annual Number of Responses = 204 a year

204

11. Hour and Cost Burden

Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

Time Per Response

Hours Per Response

Annual Hour Burden

Reporting

26.6

Minutes

0.443333333333333

90.44

Record Keeping

Hours

Third party disclosure

Hours

Total:

26.6

0.443333333333333

90.44

(Cost calculations should match the Supporting Statement Section A, question 13.)

Cost Per Response

Annual Cost Burden

Reporting

$319.20

$65,116.80

Record Keeping

$0.00

Third party disclosure

$0.00

Total:

$319.20

$65,116.80

12. Annual Responses and Burden

Change Due to

Total Requested

New Statute

Agency Discretion

Adjustment in Agency Estimate

Violation

Currently Approved

Annual Responses

204

Annual Hour Burden

Annual Cost Burden

$65,117

65,117

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Sheet 6: Part2 Form - IC (4)

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Title the IC (information collection) with potential text search in mind.

1. Title:

2. Is this a Common Form?

3. Obligation to Respond

Many or no selections is acceptable.

4. Frequency of reporting (check all that apply)

5. CFR Citation(s) for the information collection under review (if applicable)

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)

Line of Business / Subfuction

Enter if applicable. If not, leave blank.

8. Privacy Act System of Records (if applicable)

Title:

FR Citation:

Title:

Page No.:

Date:

9. Number of Respondents

Affected Public

(if Private Sector

check all that apply)

This is the basis for a burden number that is calculated.

Total #

Small Entity #

Percent Electronic

10. Frequency: How often on average will each respondent respond to the Information Collection?

Number of Responses per Respondent

Per

Year

Calculated: Annual Frequency = 0 times a year (per respondent)

Calculated: Annual Number of Responses = 0 a year

11. Hour and Cost Burden

Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

Time Per Response

Hours Per Response

Annual Hour Burden

Reporting

Hours

Record Keeping

Hours

Third party disclosure

Hours

Total:

(Cost calculations should match the Supporting Statement Section A, question 13.)

Cost Per Response

Annual Cost Burden

Reporting

$0.00

Record Keeping

$0.00

Third party disclosure

$0.00

Total:

$0.00

12. Annual Responses and Burden

Change Due to

Total Requested

New Statute

Agency Discretion

Adjustment in Agency Estimate

Violation

Currently Approved

Annual Responses

Annual Hour Burden

Annual Cost Burden

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Sheet 7: Part2 Form - IC (5)

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Title the IC (information collection) with potential text search in mind.

1. Title:

2. Is this a Common Form?

3. Obligation to Respond

Many or no selections is acceptable.

4. Frequency of reporting (check all that apply)

5. CFR Citation(s) for the information collection under review (if applicable)

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)

Line of Business / Subfuction

Enter if applicable. If not, leave blank.

8. Privacy Act System of Records (if applicable)

Title:

FR Citation:

Title:

Page No.:

Date:

9. Number of Respondents

Affected Public

(if Private Sector

check all that apply)

This is the basis for a burden number that is calculated.

Total #

Small Entity #

Percent Electronic

10. Frequency: How often on average will each respondent respond to the Information Collection?

Number of Responses per Respondent

Per

Year

Calculated: Annual Frequency = 0 times a year (per respondent)

Calculated: Annual Number of Responses = 0 a year

11. Hour and Cost Burden

Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

Time Per Response

Hours Per Response

Annual Hour Burden

Reporting

Hours

Record Keeping

Hours

Third party disclosure

Hours

Total:

(Cost calculations should match the Supporting Statement Section A, question 13.)

Cost Per Response

Annual Cost Burden

Reporting

$0.00

Record Keeping

$0.00

Third party disclosure

$0.00

Total:

$0.00

12. Annual Responses and Burden

Change Due to

Total Requested

New Statute

Agency Discretion

Adjustment in Agency Estimate

Violation

Currently Approved

Annual Responses

Annual Hour Burden

Annual Cost Burden

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Sheet 8: Part2 Form - IC (6)

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Title the IC (information collection) with potential text search in mind.

1. Title:

2. Is this a Common Form?

3. Obligation to Respond

Many or no selections is acceptable.

4. Frequency of reporting (check all that apply)

5. CFR Citation(s) for the information collection under review (if applicable)

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)

Line of Business / Subfuction

Enter if applicable. If not, leave blank.

8. Privacy Act System of Records (if applicable)

Title:

FR Citation:

Title:

Page No.:

Date:

9. Number of Respondents

Affected Public

(if Private Sector

check all that apply)

This is the basis for a burden number that is calculated.

Total #

Small Entity #

Percent Electronic

10. Frequency: How often on average will each respondent respond to the Information Collection?

Number of Responses per Respondent

Per

Business Day (5 per week) - 260 per year

260

Calculated: Annual Frequency = 0 times a year (per respondent)

Calculated: Annual Number of Responses = 0 a year

11. Hour and Cost Burden

Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

Time Per Response

Hours Per Response

Annual Hour Burden

Reporting

Hours

Record Keeping

Hours

Third party disclosure

Hours

Total:

(Cost calculations should match the Supporting Statement Section A, question 13.)

Cost Per Response

Annual Cost Burden

Reporting

$0.00

Record Keeping

$0.00

Third party disclosure

$0.00

Total:

$0.00

12. Annual Responses and Burden

Change Due to

Total Requested

New Statute

Agency Discretion

Adjustment in Agency Estimate

Violation

Currently Approved

Annual Responses

Annual Hour Burden

Annual Cost Burden

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Sheet 9: Part2 Form - IC (7)

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Title the IC (information collection) with potential text search in mind.

1. Title:

2. Is this a Common Form?

3. Obligation to Respond

Many or no selections is acceptable.

4. Frequency of reporting (check all that apply)

5. CFR Citation(s) for the information collection under review (if applicable)

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)

Line of Business / Subfuction

Enter if applicable. If not, leave blank.

8. Privacy Act System of Records (if applicable)

Title:

FR Citation:

Title:

Page No.:

Date:

9. Number of Respondents

Affected Public

(if Private Sector

check all that apply)

This is the basis for a burden number that is calculated.

Total #

Small Entity #

Percent Electronic

10. Frequency: How often on average will each respondent respond to the Information Collection?

Number of Responses per Respondent

Per

Business Day (5 per week) - 260 per year

260

Calculated: Annual Frequency = 0 times a year (per respondent)

Calculated: Annual Number of Responses = 0 a year

11. Hour and Cost Burden

Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

Time Per Response

Hours Per Response

Annual Hour Burden

Reporting

Hours

Record Keeping

Hours

Third party disclosure

Hours

Total:

(Cost calculations should match the Supporting Statement Section A, question 13.)

Cost Per Response

Annual Cost Burden

Reporting

$0.00

Record Keeping

$0.00

Third party disclosure

$0.00

Total:

$0.00

12. Annual Responses and Burden

Change Due to

Total Requested

New Statute

Agency Discretion

Adjustment in Agency Estimate

Violation

Currently Approved

Annual Responses

Annual Hour Burden

Annual Cost Burden

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Sheet 10: Part2 Form - IC (8)

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Title the IC (information collection) with potential text search in mind.

1. Title:

2. Is this a Common Form?

3. Obligation to Respond

Many or no selections is acceptable.

4. Frequency of reporting (check all that apply)

5. CFR Citation(s) for the information collection under review (if applicable)

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)

Line of Business / Subfuction

Enter if applicable. If not, leave blank.

8. Privacy Act System of Records (if applicable)

Title:

FR Citation:

Title:

Page No.:

Date:

9. Number of Respondents

Affected Public

(if Private Sector

check all that apply)

This is the basis for a burden number that is calculated.

Total #

Small Entity #

Percent Electronic

10. Frequency: How often on average will each respondent respond to the Information Collection?

Number of Responses per Respondent

Per

Business Day (5 per week) - 260 per year

260

Calculated: Annual Frequency = 0 times a year (per respondent)

Calculated: Annual Number of Responses = 0 a year

11. Hour and Cost Burden

Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

Time Per Response

Hours Per Response

Annual Hour Burden

Reporting

Hours

Record Keeping

Hours

Third party disclosure

Hours

Total:

(Cost calculations should match the Supporting Statement Section A, question 13.)

Cost Per Response

Annual Cost Burden

Reporting

$0.00

Record Keeping

$0.00

Third party disclosure

$0.00

Total:

$0.00

12. Annual Responses and Burden

Change Due to

Total Requested

New Statute

Agency Discretion

Adjustment in Agency Estimate

Violation

Currently Approved

Annual Responses

Annual Hour Burden

Annual Cost Burden

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Sheet 11: Part2 Form - IC (9)

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Title the IC (information collection) with potential text search in mind.

1. Title:

2. Is this a Common Form?

3. Obligation to Respond

Many or no selections is acceptable.

4. Frequency of reporting (check all that apply)

5. CFR Citation(s) for the information collection under review (if applicable)

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)

Line of Business / Subfuction

Enter if applicable. If not, leave blank.

8. Privacy Act System of Records (if applicable)

Title:

FR Citation:

Title:

Page No.:

Date:

9. Number of Respondents

Affected Public

(if Private Sector

check all that apply)

This is the basis for a burden number that is calculated.

Total #

Small Entity #

Percent Electronic

10. Frequency: How often on average will each respondent respond to the Information Collection?

Number of Responses per Respondent

Per

Business Day (5 per week) - 260 per year

260

Calculated: Annual Frequency = 0 times a year (per respondent)

Calculated: Annual Number of Responses = 0 a year

11. Hour and Cost Burden

Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

Time Per Response

Hours Per Response

Annual Hour Burden

Reporting

Hours

Record Keeping

Hours

Third party disclosure

Hours

Total:

(Cost calculations should match the Supporting Statement Section A, question 13.)

Cost Per Response

Annual Cost Burden

Reporting

$0.00

Record Keeping

$0.00

Third party disclosure

$0.00

Total:

$0.00

12. Annual Responses and Burden

Change Due to

Total Requested

New Statute

Agency Discretion

Adjustment in Agency Estimate

Violation

Currently Approved

Annual Responses

Annual Hour Burden

Annual Cost Burden

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Sheet 12: Part2 Form - IC (10)

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

Title the IC (information collection) with potential text search in mind.

1. Title:

2. Is this a Common Form?

3. Obligation to Respond

Many or no selections is acceptable.

4. Frequency of reporting (check all that apply)

5. CFR Citation(s) for the information collection under review (if applicable)

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

Title:

Part:

7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)

Line of Business / Subfuction

Enter if applicable. If not, leave blank.

8. Privacy Act System of Records (if applicable)

Title:

FR Citation:

Title:

Page No.:

Date:

9. Number of Respondents

Affected Public

(if Private Sector

check all that apply)

This is the basis for a burden number that is calculated.

Total #

Small Entity #

Percent Electronic

10. Frequency: How often on average will each respondent respond to the Information Collection?

Number of Responses per Respondent

Per

Business Day (5 per week) - 260 per year

260

Calculated: Annual Frequency = 0 times a year (per respondent)

Calculated: Annual Number of Responses = 0 a year

11. Hour and Cost Burden

Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

Time Per Response

Hours Per Response

Annual Hour Burden

Reporting

Hours

Record Keeping

Hours

Third party disclosure

Hours

Total:

(Cost calculations should match the Supporting Statement Section A, question 13.)

Cost Per Response

Annual Cost Burden

Reporting

$0.00

Record Keeping

$0.00

Third party disclosure

$0.00

Total:

$0.00

12. Annual Responses and Burden

Change Due to

Total Requested

New Statute

Agency Discretion

Adjustment in Agency Estimate

Violation

Currently Approved

Annual Responses

Annual Hour Burden

Annual Cost Burden

View / Edit Part 1 - [Financial Institution Data Matc]

Go to Template Summary

File Type	application/vnd.ms-excel
Author	Parallels
Last Modified By	OCSE
File Modified	2011-02-23
File Created	2006-10-20