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Submission for OMB Review; Comment Request

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May 1, 2012.

The Department of the Treasury will submit the following information collection request to the Office of Management and Budget (OMB) for review and clearance in accordance with the Paperwork Reduction Act of 1995, Public Law 104-13, on or after the date of publication of this notice.


Comments should be received on or before June 4, 2012 to be assured of consideration.


Send comments regarding the burden estimate, or any other aspect of the information collection, including suggestion for reducing the burden to the (1) Office of Information and Regulatory Affairs, Office of Management and Budget, Attention: Desk Officer for Treasury, New Executive Office Building, Room 10235, Washington, DC 20503, or email at OIRA_Submission@OMB.EOP.GOV and the (2) Treasury PRA Clearance Officer, 1750 Pennsylvania Ave. NW., Suite 11020, Washington, DC 20220, or on-line at


Copies of the submission(s) may be obtained by calling (202) 927-5331, email at, or the entire information collection request may be found at

Financial Management Service (FMS)

OMB Number: 1510-XXXX.

Type of Review: New Collection.

Title: Request for Payment of Federal Benefit by Check, EFT Waiver Form.

Abstract: 31 CFR part 208 requires that all Federal non-tax payments be made by electronic funds transfer (EFT). This form is used to collect information from individuals requesting a waiver from the EFT requirement because of a mental impairment and/or who live in a remote geographic location that does not support the use of EFT. These individuals may continue to receive payment by check. However, 31 CFR part 208 requires individuals requesting one of these waiver conditions to submit a written justification that is notarized by a notary public. In order to assist individuals with this submission, Treasury is preparing a waiver form so that all necessary information is collected.

Affected Public: Individuals or Households.

Estimated Total Burden Hours: 3,000.

Robert Dahl,

Treasury PRA Clearance Officer.

[FR Doc. 2012-10792 Filed 5-3-12; 8:45 am]