Information Collection

Claim Against the United States for the Proceeds of a Government Check

IC 15380 under ICR 201802-1530-001 · OMB 1530-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1530-0010 can be found here:

Documents and Forms

Document Name Document Type
Form FMS 1133 Claim Against the United States for the Proceeds of a Government Check Form and Instruction
FMS 1133 Claim Against the United States for the Proceeds of a Go 1530-0010_FMS_1133_APR94(2).pdf Form and Instruction
FS Form 1133-A Claim Against the United States for Proceeds of a Govern Blank BFS 1133a.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claim Against the United States for the Proceeds of a Government Check	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FMS 1133	Claim Against the United States for the Proceeds of a Government Check	1530-0010_FMS_1133_APR94(2).pdf		Yes	No	Printable Only
Form and Instruction	FS Form 1133-A	Claim Against the United States for Proceeds of a Government Check (SSA)	Blank BFS 1133a.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title: Treasury/FMS .002 Payment Records	FR Citation: 77 FR 62602

Number of Respondents: 51,640	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	51,640	51,640
Annual IC Time Burden (Hours)	8,609	8,609
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.