Information Collection

Repayment by Credit Card

IC 45464 under ICR 202507-3220-007 · OMB 3220-0169.

Documents and Forms

Document Name Document Type
Form G-421F (04-20) Repayment by Credit Card - Current Repayment by Credit Card Form
G-421F (04-20) Repayment by Credit Card - Current Form G-421F (04-20).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Repayment by Credit Card	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 340

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	G-421F (04-20)	Repayment by Credit Card - Current	Form G-421F (04-20).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title: Railroad Unemployment and Sickness Insurance Benefit System	FR Citation: 79 FR 58874

Number of Respondents: 175	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	175	175
Annual IC Time Burden (Hours)	15	15
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.

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