INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-I: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
0560-0183 |
|
|
|
|
|
|
|
|
|
|
|
| Assignments of Payments and Joint Payment Authorization; Request for Waiver |
|
|
|
|
| DATE PREPARED |
|
|
|
| August 5, 2021 |
|
|
|
|
|
|
|
|
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
|
|
|
|
REPORTS |
|
RECORDS |
RESPONDENT COST |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL BURDEN HOURS |
|
|
TOTAL |
|
|
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
(Col. F x G) |
NO. OF |
ANNUAL |
RECORD- |
COST |
TOTAL |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
(H) |
RECORD- |
HOURS PER |
KEEPING HOURS |
PER |
COST |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
|
|
KEEPERS |
RECORD- |
(Col. I x J) |
HOUR |
(Col. H x L) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
EXEMPT |
NON-EXEMPT |
|
KEEPER |
|
|
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
|
|
(I) |
(J) |
(K) |
(L) |
(M) |
| 7 CFR 1404.4 |
Assignment of Payments |
CCC-36 or CCC-36 (SP) |
536,540 |
1 |
536,540 |
0.17 |
|
89,423 |
|
|
|
$53.71 |
4,802,908 |
| None |
Joint Payment Authorization |
CCC-37 or CCC- 37 (SP) |
74,354 |
1 |
74,354 |
0.17 |
|
12,392 |
|
|
|
$53.71 |
665,566 |
| 7 CFR 1404.4 |
Notice of Assignment |
FSA-251 |
7 |
1 |
7 |
0.17 |
|
1 |
|
|
|
$53.71 |
53 |
| None |
Instrument of Assignment |
FSA-252 |
7 |
1 |
7 |
0.08 |
|
1 |
|
|
|
$53.71 |
53 |
| 31 CFR Part 208 |
Request For FSA Payment of Federal Benefits by Check |
FPAC-FM-12 |
89,583 |
1 |
89,583 |
0.17 |
|
14,871 |
|
|
|
$53.71 |
798,709 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
116,687 |
|
|
|
|
|
|
SUBTOTAL |
|
|
|
700,491 |
|
0 |
116,687 |
|
|
0.00 |
|
6,267,289 |
|
TOTAL OF ALL PAGES |
|
|
|
700,491 |
|
|
116,687 |
|
|
0.00 |
|
6,267,289 |
| TOTAL - COLUMNS "F" AND "I" = OMB 83-I, 13b; COLUMNS "H" AND "K" = OMB 83-I, 13c |
|
|
|
700,491 |
|
|
116,687 |
|
|
|
|
|