1530-0019_Supporting Stmt_2025

Supporting Statement

OMB No. 1530-0019

Request for Payment of Federal Benefit by Check

(FS Form 1201W & FS 1201W-DFAS)

1. Justifications.

1. Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.

Federal law (31 U.S.C. 3332 and 31 CFR 208) requires that all Federal benefit and other nontax payments be made electronically. Qualifying individuals may request a waiver and continue receiving payments by paper check through submitting FS Form 1201W.

The Defense Finance and Accounting Service (DFAS), Department of Defense, has asked Treasury to assist them in reviewing and approving or rejecting requests by their recipients of a military benefit to continue receiving payment by check. Fiscal Service will offer DFAS users the FS 1201W-DFAS, which is the same as the FS-1201W except for a few modifications to accommodate military benefits recipients.

2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.

Treasury’s fiscal agent, the Federal Reserve Bank of Dallas, operates the EFT waiver process on Treasury’s behalf. This office will receive and review these waiver request forms to ensure that they are completed properly and include a valid justification for a waiver from the EFT requirement, as outlined in 31 CFR Part 208. If the waiver is accepted, the Dallas representative will reflect this in their waiver database so the recipient can continue to receive payment by check.

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? What consideration is given to use information technology to reduce burden?

The forms are available from the Bureau of the Fiscal Service and also on the Internet as a fill-in PDF form, but only paper forms may accepted in this process.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

The information is collected for a single purpose when it is necessary for an individual to substantiate in writing why they cannot receive payment by EFT. No other federal governmental agency collects this type of information, therefore, no duplication exists.

5. If the collection of information impacts small businesses or other small entities (Item 5 of OMB Form 83-I), describe any methods used to minimize burden.

Only individuals may request a waiver and therefore the collection of information applies only to individuals, not to small businesses 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, as well as any technical or legal obstacles to reducing burden.

Failure to collect this information would violate the requirements of 31 CFR Part 208 and prevent individuals from exercising their right under the regulation to obtain a waiver from the EFT requirement.

7. Is this collection of information conducted in a manner consistent with the guidelines of 5 CFR 1320.6?

There are no special circumstances. The collection of information is conducted in a manner consistent with the guidelines in 5 CFR 1320.6.

8. What effort was made to notify the general public about this collection of information?

The Bureau published a 60-day notice in the Federal Register on October 23, 2024, Volume 89, Page 84671 to solicit comments from the public on the extension of this collection of information; no comments were received.

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

There are no payments or gifts made to respondents.

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, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

Individuals requesting a waiver from the EFT requirement due to a mental impairment must explain how the mental impairment necessitates receipt of their payments by paper check. This information will only be used to validate that a waiver is necessary and the information will not be disclosed to any other parties.

An applicable System of Records Notice for this information was published February 27, 2020. System of Records Name: Treasury/Fiscal Service .007, “Direct Deposit Enrollment Records”. The privacy impact assessment (PIA) conducted for this collection of information can be found at https://www.fiscal.treasury.gov/files/pia/pps-pclia2.pdf

12. Provide estimates of the hour burden of the collection of information. The statement should: *indicate the number of respondents, frequency of response, annual hour burden; and an explanation of how the burden was estimated.

It is estimated that 3,250 recipients will apply for a waiver from the EFT requirement. They will only need to complete the waiver response one time, unless the form is incomplete and has to be returned to the recipient. The estimated annual burden hours are 1,083 (20 minutes per form).

	# Respondents	# Responses Per Respondent	Annual Responses	Hours Per Response	Total Burden
1201W	2,790	1	2,790	.33	930
1201W (SP)	210	1	210	.33	70
1201W-DFAS	250	1	250	.33	82.5
TOTAL	3,250	1	3,250	.33	1,082.5

Estimate of Annual Respondent Cost.

Form	No. of Respondents	Number of Responses per Respondent	Average Burden per Response (in hours)	Total Annual Burden (in hours)	Average Hourly Wage Rate1	Total Annual Respondent Cost
1201W	2,790	1	20 minutes (0.33 hours)	930	$45.33	$42,156.90
1201W (SP)	210	1	20 minutes (0.33 hours)	70	$45.33	$3,173.10
1201W-DFAS	250	1	20 minutes (0.33 hours)	82.5	$45.33	$3,739.73
Total Respondent Cost:						$49,069.732790

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

There are no capital/start-up or ongoing operation/maintenance costs associated with this information collection.

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

The costs to administer the waiver process are included in Treasury’s overall reimbursement to the Federal Reserve Bank as a fiscal agent to operate the Go Direct program is $2,373 in postage.

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

No changes or adjustments are reported for this renewal.

16. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

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

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.

We are seeking approval not to display the expiration date of the OMB approval. Identifying this date may cause confusion with the respondent on when form must be submitted to the bureau for consideration; as well as multiple printings of the form may reflect conflicting dates if older stock is retained for distribution.

18. Explain each exception to the certification statement.

There are no exceptions to the certification statement.

B. Collections of Information Employing Statistical Methods

No statistical methods are being employed for this collection of information.

1 It is expected that respondents to this collection could be from any occupation. The average wage rate for all occupations is $ $27.07 according to the May 2023 National Occupational Employment and Wage Estimates. https://www.bls.gov/oes/current/oes_nat.htm A benefit multiplier of 1.44 is used to calculate a fully-loaded wage rate of $31.48*1.44=$45.33

Using the BLS Employer Costs for Employee Compensation – March 2020 report https://www.bls.gov/news.release/pdf/ecec.pdf, a benefit multiplier of 1.44 was calculated by taking the private industry worker 50^th (median) wage percentile total compensation rate divided by the wages and salaries rate. $26/$18.05=1.44

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