FR 3054a Government Prepaid Card Survey - State Government Survey

---

Overview

1-Response form
2-Data

---

Sheet 1: 1-Response form

Government Prepaid Card Program Survey

FR XXXX OMB. No. 7100-[NEW] Approval Expires XXX. 2011

Depository Institution Survey

FR XXXX

Response form

Affiliates covered in this survey response

Primary contact for this survey response

Name:

Email:

Phone:

This report is required by law [Pub. L. 111-203, § 1075, 124 Stat. 1376 (2010)]. The Federal Reserve System regards the individual organization information provided by each respondent as confidential (5 U.S.C. § 552(b)(4)). If it should be determined subsequently that any information collected on this form must be released, the respondents will be notified. The Federal Reserve may not conduct or sponsor, and an organization (or a person) is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to average xxx hours per response, including the time to gather the data in the required form and to review instructions and complete the information collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, N.W., Washington, D.C. 20551, or via email to regs.comments@frb.gov; and to the Office of Management and Budget, Paperwork Reduction Project (7100-0079), Washington, D.C. 20503.

Please refer to the instructions that accompanied this survey. Do not leave any cells in the survey blank. If a response to a particular cell does not exist, enter a 0. If a response to a particular cell cannot be determined, enter DK for “don’t know.” If you have other questions or difficulties, Board staff can assist you. Please call Jennifer Williams at 202-452-2446 or email Interchange.Survey@frb.gov for assistance. Provide your name, organization, and contact information along with your inquiry when you call or email.

---

Sheet 2: 2-Data

Government Prepaid Card Program Survey		Total	Prepaid Card Program 1	Prepaid Card Program 2	Prepaid Card Program 3	Prepaid Card Program 4	Prepaid Card Program 5
State Government Survey
FR XXXX
I. Program information
	A. Program name
	B. State or local program
	C. Sponsoring agency
	D. Description of payment type
	E. Number of recipients receiving payments on prepaid cards on 12-31-2010
	F. Total number of recipients receiving payments (all payment types) on 12-31-2010
II. Accounts
	A. Number of accounts open on 12-31-2010
	B. Number of accounts opened in 2010
	C. Number of accounts closed in 2010
	D. Average number of accounts open during 2010
III. Cards
	A. Number of cards outstanding on 12-31-2010
	B. Number of newly-issued cards for new or existing accounts in 2010
	C. Number of cards associated with accounts closed in 2010
	D. Average number of cards during 2010
IV. Cards by network type
	A. Number of cards outstanding on 12-31-2010 that can be used on both a signature and PIN network
	B. Number of cards outstanding on 12-31-2010 that can be used on a signature network only
	C. Number of cards outstanding on 12-31-2010 that can be used on a PIN network only
	D. Number of cards outstanding on 12-31-2010 that can be used to make ATM cash withdrawals
V. Funding
	A. Dollar value of funds loaded into prepaid card accounts in 2010
	B. Dollar value of funds outstanding on prepaid card accounts on 12-31-2010
	C. Total value of all funds paid (all payment types) in 2010
VI. ATM transactions
	A. Number of ATM withdrawals in 2010
	B. Dollar value of ATM withdrawals in 2010
VII. Purchase transactions
	A. Number of purchase transactions in 2010
	B. Number of signature-based purchase transactions in VII.A.
	C. Number of PIN-based purchase transactions in VII.A.
	D. Number of purchase transactions in VII.A. that were in a card-present environment
	E. Number of purchase transactions in VII.A. that were in a card-not-present environment
	F. Number of purchase transactions in that included cash back
VIII. Purchase transaction value
	A. Dollar value of purchase transactions in 2010
	B. Dollar value of signature-based purchase transactions in VIII.A.
	C. Dollar value of PIN-based purchase transactions in VIII.A.
	D. Dollar value of purchase transactions in VIII.A. that were in a card-present environment
	E. Dollar value of purchase transactions in VIII.A. that were in a card-not-present environment
	F. Dollar value of cash back provided
IX. Interchange fees
	A. Dollar value of interchange fees received by card issuer on purchase transactions in 2010
	B. Dollar value of interchange fees received by card issuer in IX.A. for signature-based transactions
	C. Dollar value of interchange fees received by card issuer in IX.A. on PIN-based transactions
	D. Dollar value of interchange fees paid by card issuer on ATM withdrawals in 2010
X. Cardholder fees
	A. Dollar value of all fees charged to cardholders in 2010
	B. Dollar value of annual or monthly fees in X.A. charged to cardholders in 2010
	C. Dollar value of balance inquiry or other account servicing fees in X.A. charged to cardholders in 2010
	D. Dollar value of penalty fees in X.A. charged to cardholders in 2010
	E. Dollar value of ATM fees in X.A. charged to cardholders in 2010
	F. Dollar value of routine transaction fees in X.A. charged to cardholders in 2010
	G. Dollar value of all other fees in X.A. charged to cardholders in 2010
XI. Government agency fees
	A. Gross dollar value of all fees charged to the government agency in 2010
	B. Dollar value of interchange fees transferred to the government agency in 2010
	C. Dollar value of cardholder fees transferred to the government agency in 2010
	D. Dollar value of other discounts and incentives provided to the government agency in 2010
	E. Net dollar value of fees charged to the government agency in 2010