SupportingStatement_1530-0011_2016

Supporting Statement

OMB No. 1530-0011

Assignment Form (FS Form 6314)

Justification.

1. Explain the circumstances that make the collection of information necessary.

Under the International Claims Settlement Act of 1949, as amended, the War Claims Act of 1928, as amended, and the War Claims Act of 1948, the Department of the Treasury has the responsibility of making payments on awards and on divested accounts from funds made available for these purposes. The Assignment Form is used by an award holder who wishes to assign or transfer all or part of his award to another person. In assigning the award, the award holder forfeits his rights to the portion assigned and the assignee becomes the owner of that portion. This form is often used to assign a portion to a lawyer to cover attorney’s fees.

2. Indicate how, by whom, and for what purpose the information is to be used.

The information on the completed form is used by the Department of the Treasury, Bureau of the Fiscal Service to process a request to assign or transfer all or part of an award to another person.

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology.

The form is available from the Bureau of the Fiscal Service as a fill-in PDF form.

4. Describe efforts to identify duplication.

The Judgment Fund Branch is the only office making payments under the International Claims Settlement Act of 1949, the War Claims Act of 1928, and the War Claims Act of 1948. Since no other office is involved in processing payments for these awards, duplication of this information collection should not occur.

5. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.

This collection of information does not impact small business or other small entities.

6. Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently.

There would be no consequences to Federal program or policy activities trying to change the frequency of collection. This collection of information is requested on an as needed basis, whenever an award holder wishes to assign a portion of his award to someone else.

7. Explain any special circumstances that would require data collection to be inconsistent with guidelines in 5 CFR 1320.5(d)(2).

There are no special circumstances that requires the collection to be conducted in a manner inconsistent with 5 CFR 1320.5(d)(2).

8. Consultation with individuals outside of the Agency on availability of data, frequency of collection, clarity of instructions and forms, and data elements.

A 60-day notice was published in the Federal Register on August 22, 2016, at 81 FR 56754 soliciting comments. No comments were received regarding this information collection.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

There are no gifts or payments to respondents associated with this information collection.

10. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

Aside from protections contained in the Privacy Act, there is no guarantee of confidentiality.

11. Provide additional justification for any questions of a sensitive nature.

There are no sensitive questions in the information collection. Information collected on the form is necessary to assign or transfer all or part of an award to another person. An applicable System of Records Notice was published October 15, 2012 that applies if a customer seeking a waiver submits sensitive information. System of Records Name: Treasury/FMS.003 – Claims and Inquiry on Treasury Checks, and International Claimants.

12. Provide estimates of the hour burden of the collection of information.

No. of Respondents	No. of Responses Per Respondent	No. Annual Responses	Hours Per Response	Total Annual Burden
150	1	150	0.50	75

This was based on a combination of factors: a) Past experience working with the respondents who have come to the office for assistance in completing the form; b) Running tests with employees in the office to see how long it took to complete the form, and c) An estimate of the time it would take the respondents to have a corporate seal placed on the form similar to notarization.

13. Provide an estimate for the total annual cost burden to respondents or record keepers resulting from the collection of information.

There is no annual cost to respondent. The respondent would complete the form (fillable/signable PDF) and send it in. There are no start up costs of operational and maintenance costs. The only cost the respondent may incur would be cost of postage to mail in the form.

14. Provide estimates of annualized costs to the Federal government.

Annualized cost to the Federal Government is includes mailing and printing costs, review and verifying information is estimated to be $2,294.

15. Explain the reasons for any program changes or adjustments.

There are no changes in the burden hours. This request is for renewal purposes only.

16. Plans for tabulation, statistical analysis and publication.

The results of this information collection will not be published for statistical purpose.

17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

Non-display of OMB expiration date would eliminate any confusion by the respondent when the form is required by the bureau and the need to revise the form with each renewal when no other changes to the form have occurred.

18. Explain each exception to the certification statement on OMB Form 83-I.

There are no exceptions to the certification statement.

1. Collections of Information Employing Statistical Methods

This information collection does not employ statistical methods.

3