1

FR 3063a 

OMB No. 7100-0343 

Approval expires December 31, 2014 

GOVERNMENT-ISSUED, GENERAL-USE 

PREPAID CARD SURVEY

Issuer Survey 

Survey Period: 

Calendar Year 2011 
2

General Instructions 

About this Survey 

The information requested is required by law [15 U.S.C. 1693o-2] to support an annual report to the 

Congress on the prevalence of the use of general-use prepaid cards in federal, state, or local 

government-administered payment programs, and the interchange fees and cardholder fees charged with 

respect to the use of such general-use prepaid cards. 

Your Participation 

To achieve the most reliable results, it is important that you respond completely and accurately. Please 

leave no survey item blank. 

The survey should be completed in aggregate for all government-administered payment programs and for 

each government-administered payment program individually for which you are the issuer. Sections II 

through X should be repeated as many times as needed to provide the requested data on each 

government-administered payment program. 

There are three possible ways to answer a survey question: 

Enter a Value: The actual numeric value of the data element. 

Enter a Zero: When the calculated value equals zero. Please do not enter a non-numeric 

value, e.g. “NA” or “NR,” when the value equals zero. 

Enter “NR” (Not Reported): If your institution engages in the activity of the type being 

measured but you are unable to report a figure that reflects that activity. 

Please do not enter “NA.” 

If for any reason you cannot provide complete data or you have questions please contact 

Jennifer Williams at 202-452-2446 or e-mail debit.card.surveys@frb.gov for assistance. 

The survey will be made available online at https://www.federalreserve.gov/debitcardsurveys. 

Please complete the survey by April 16, 2012. 

Response Confidentiality and Burden 

The Federal Reserve Board regards the individual organization information provided by each respondent 

as confidential (5 U.S.C. § 552(b)(4)). The Board, however, may publish aggregate or summary 

information in a way that does not reveal your individual organization’s confidential information. If it 

should be determined subsequently that any information collected on this form must be released, the 

respondents will be notified. 

 

Public reporting burden for this collection of information is estimated to be 50 hours per response, 

including the time to gather data in the required form and to review instructions and complete the 

information collection. Send comments regarding this burden estimate or any other aspect of this 

collection of information, including suggestions for reducing the burden, to Secretary, Board of Governors 

of the Federal Reserve System, 20th and C Streets, N.W., Washington, D.C. 20551 or via email to 

regs.comments@frb.gov; and to the Office of Management and Budget, Paperwork Reduction Project 

(7100-to be assigned), Washington, D.C. 20503. The Federal Reserve may not conduct or sponsor, and 

an organization (or a person) is not required to respond to, a collection of information unless it displays a 

currently valid OMB control number. 
3

Section I: Respondent Information 

1. Name of the card issuer covered in this response 

2. Contact person(s) by section of the survey for which responsible 

Name Email 

Section Phone 

 

Name Email 

Section Phone 

 

Name Email 

Section Phone 

 

Name Email 

Section Phone 

 

Name Email 

Section Phone 

 

Name Email 

Section Phone 

 

Name Email 

Section Phone 

 

Name Email 

Section Phone 

 

Name Email 

Section Phone 
4

Section II: Government-Administered, General-Use 

Prepaid Card Program Information 

Please enter totals only for transactions related to government-administered, general-use prepaid cards 

linked to U.S.-domiciled accounts involving a merchant located in the United States during calendar year 

(CY) 2011. 

For sections II through X, provide totals in aggregate for all government-administered payment programs for 

which you are the general-use prepaid card issuer. Then repeat sections II through X (as many times as 

needed) to provide totals for each government-administered payment program individually (as listed in 

Question 1 below) for which you are the general-use prepaid card issuer. Unless otherwise noted, totals 

should be reported on a program basis.

Include: All general-use prepaid card programs administered by a federal, state, or local government 

agency. Examples of such general-use card programs include, but are not limited to, federal benefit 

programs (such as Social Security Administration, Supplemental Security Income, and Veterans 

Administration), electronic benefit transfer programs (such as the Supplemental Nutrition Assistance 

Program (SNAP)), cash assistance programs (such as Temporary Assistance to Needy Families and 

the Heating and Energy Assistance Program), payroll programs, child support programs, 

reimbursement programs, disaster relief programs, and petty cash programs. 

 

Specific instructions for Section II when reporting in aggregate:

 List the name of each individual program covered in 1. 

Check all that apply in 2. 

List all relevant jurisdictions that apply in 3. 

List all relevant sponsoring government agencies in 4. 

Provide a description of each program covered in 5. 

Report the total number of recipients receiving payments for all programs in 6. and check all that apply 

when specifying how recipients are counted. 

1. Name of government-administered payment program(s) covered in this response 

2. Does this response cover federal, state, or local

program(s)? 

For reporting totals for an individual program, check only one. 

Federal

[ ] 

State 

[ ] 

 

Local

[ ] 

3. Jurisdiction(s) 

Geographic area in which the government-administered, general-use prepaid cards have been issued (e.g. 

nationally, specific state(s), county/counties, municipality/municipalities). 

4. Sponsoring government agency/agencies 

Government agency/agencies administering the general-use prepaid card program 
5

5. Description of government-administered payment program 

Please provide the type of program (e.g. medical benefit, unemployment insurance, child support, SNAP, inkind assistance). 

 Number

6. Recipients receiving payments on governmentadministered, general-use prepaid cards as of 

December 31, 2011 

Count each individual, household, or other category only once. 

Please specify how recipients are counted: 

For reporting totals for an individual program, check 

only one. 

Individual

[ ] 

Household 

[ ] 

Other

[ ] 

 If other, please specify: 

 

Section III: Government-Administered Payment Cards 

 Number

1. Government-administered, general-use prepaid 

cards outstanding as of December 31, 2011

1a. Government-administered, general-use prepaid cards 

for which cardholders receive benefits or 

payments from multiple programs as of 

December 31, 2011 

If responding in aggregate, please list all programs covered within this response for which 1a.

applies:
6

Government-administered, general-use prepaid 

cards by network type 

Number

2. Allocate “1. Government-administered, generaluse prepaid cards outstanding as of December 31, 

2011” between the following categories: 

2a + 2b + 2c = 1 

1: 

2a. Government-administered, general-use prepaid

cards that can be used on both dual-message 

(signature) and single-message (PIN) 

networks as of December 31, 2011 

2a.1 Government-administered, general-use 

prepaid cards that can be used on two or 

more unaffiliated networks as of 

December 31, 2011 

2b. Government-administered, general-use prepaid

cards that can be used only on a dual-message 

(signature) network as of December 31, 2011 

2c. Government-administered, general-use prepaid

cards that can be used only on a singlemessage (PIN) network as of December 31, 

2011 

Section IV: Funding 

Value ($)

1. Funds loaded onto government-administered, generaluse prepaid cards in 2011 

2. Funds outstanding on government-administered, 

general-use prepaid cards as of December 31, 2011 
7

Section V: ATM Transactions

 Number

1. Government-administered, general-use prepaid 

cards outstanding as of December 31, 2011 that can 

be used to make ATM cash withdrawals

 

 Volume Value ($)

2. Total ATM cash withdrawals in 2011 

 

Dollars ($)

3. Total ATM fees assessed for cash withdrawals in 2011 

by ATM operators at nonproprietary (out-ofnetwork) ATMs 

 

Section VI: Purchase Transactions

 Volume Value ($)

1. Settled purchase transactions in 2011 (excluding 

pre-authorizations, denials, adjustments, and returns)

 

1a. Settled purchase transactions that 

included cash back 

Transactions by network type Volume Value ($)

2. Allocate “1. Settled purchase transactions in 2011”

between the following categories: 

2a + 2b = 1 

1: 1: 

2a. Dual-message (signature) transactions 

2b. Single-message (PIN) transactions 
8

Section VII: Interchange Fees 

Interchange fee revenues Dollars ($)

1. Total interchange fee revenues received on 

settled purchase transactions in 2011 (net of interchange 

fees reimbursed to acquirers as a result of chargebacks or 

returns)

 

2. Allocate “1. Total interchange fee revenues 

received on settled purchase transactions in 2011”

between the following categories: 

2a + 2b = 1 

 1: 

2a. Interchange fee revenues received on dualmessage (signature) transactions

2b. Interchange fee revenues received on singlemessage (PIN) transactions

Section VIII: Fees Paid by Issuers

Dollars ($)

1. Fees paid on ATM cash withdrawals to ATM 

owners/operators in 2011

 

2. Fees paid on over-the-counter at-bank (teller) 

cash withdrawals to other entities in 2011

 

3. Other fees paid on cash withdrawals in 2011 

Please list other fees paid on cash withdrawals included in 3.: 

 
9

Section IX: Revenues from Cardholder Fees 

Purchase transaction fees: Fees assessed to a government-administered, general-use prepaid cardholder 

for usage of the card to make purchases. Examples include fees assessed for card usage at the point-ofsale. 

ATM fees: Fees assessed to a government-administered, general-use prepaid cardholder for proprietary 

(in-network) or non-proprietary (out-of-network) cash withdrawals at an ATM. 

Over-the-counter at-bank (teller) cash withdrawal fees: Fees assessed to a government-administered, 

general use prepaid cardholder for initiating a cash withdrawal at a bank teller location. 

Account servicing fees: Fees assessed to a government-administered, general-use prepaid cardholder that 

includes allowing the account balance to fall below a certain amount, initiating on-line bill payment 

transactions (including fees for individual or recurring payments, proof of payment requests, research 

requests, stop payment requests, and returned items), transferring funds from the general-use prepaid card 

to a bank account, converting currency, initiating a cash withdrawal at a money service transmitter, 

requesting standard or expedited card replacement, or requesting check issuance. 

Routine monthly fees: Fees assessed to a government-administered, general-use prepaid cardholder, on a 

monthly basis, for general maintenance of the general-use prepaid card. 

Customer service inquiry fees: Fees assessed to a government-administered, general-use prepaid 

cardholder that includes human interaction between the cardholder and the issuer (such as customer 

service calls to a live representative) and checking the available balance or recent activity on a card via an 

ATM, an automated interactive voice response menu (via landline or cell phone), or web-based account 

access. 

Penalty fees: Fees assessed to a government-administered, general-use prepaid cardholder for the 

infraction of an issuer’s rules or policies. Examples of penalty fees include daily limit fees (i.e., 

circumstances where a cardholder exceeded the transaction amount allowed on a daily basis), inactivity 

fees (such as fees assessed after a period of time without deposit, purchase, withdrawal, or other 

transaction activity), or account termination fees. Do not include overdraft fees. 

Overdraft fees: Fees assessed to a government-administered, general-use prepaid cardholder for a 

negative balance (a transaction that was paid despite insufficient funds on the card) or a denied transaction 

(a transaction that was denied for insufficient funds). 

Other fees: Any fees not included in the other fee categories that are assessed to a governmentadministered, general-use prepaid cardholder. 

Note: Volume data will be collected in Section X. 

 
10

Total revenues Dollars ($)

1. Total revenue received on fees assessed to 

cardholders in 2011

 

2. Allocate “1. Total revenue received on fees 

assessed to cardholders in 2011” between the 

following categories: 

2a + 2b + 2c + 2d + 2e + 2f + 2g + 2h + 2i = 1 

 1: 

2a. Purchase transaction fees assessed to 

cardholders in 2011 

2b. ATM fees assessed to cardholders in 2011 

Do not include ATM operator fees for transactions at 

nonproprietary ATMs reported in V.3

 

2c. Over-the-counter at-bank (teller) cash 

withdrawal fees assessed to cardholders in 2011 

 

2d. Account servicing fees assessed to cardholders 

in 2011 

 

2e. Routine monthly fees assessed to cardholders 

in 2011 

 

2f. Customer service inquiry fees assessed to 

cardholders in 2011 

 

2g. Penalty fees assessed to cardholders in 2011 

2h. Overdraft fees assessed to cardholders in 2011 

2i. Other fees assessed to cardholders in 2011 

Please list types of fees included in 2i.:

 
11

Section X: Fees Assessed to Cardholders 

Minimum and maximum values may be the same. 

1. Purchase transaction fees 

If reporting in aggregate, respond only to question 1c.

1a. Were purchase transaction fees

assessed to cardholders in 2011? 

 If no, proceed to question 2a. 

Yes

[ ] 

No 

[ ] 

1a.1 Were these purchase

transaction fees subject to 

government-imposed restrictions?

Yes

[ ] 

No 

[ ] 

Please describe government-imposed restrictions: 

1b. Were any of these purchase transaction 

fees waived or for some other reason not 

assessed to cardholders in 2011? 

If no, proceed to 1c. 

Yes

[ ] 

No 

[ ] 

Number

1b.1 Total number of purchase transaction 

fees waived or for some other reason not 

assessed to cardholders. 

 

1b.2 Was the number of 

purchase transaction 

fees waived or for some 

other reason not assessed in 

1b.1 allotted to the 

cardholder monthly, per 

deposit to the card, or using 

some other unit of measure? 

Monthly 

[ ] 

Per 

deposit 

to card 

[ ] 

Other 

[ ] 

If other, specify unit of measure: 

 

 
12

Number

1c. Total number of purchase transaction fees 

assessed to cardholders in 2011 

Do not include the number of transactions for which 

purchase transaction fees were waived or for some other 

reason not assessed to cardholders.

Dollars ($)

1c.1 Minimum purchase transaction fee

assessed to cardholders in 2011 (per purchase 

transaction) 

Include only fees greater than $0.00. 

1c.2 Maximum purchase transaction fee

assessed to cardholders in 2011 (per purchase 

transaction) 

 

Optional: Please provide a brief description of the fee structure applicable to responses under 1.: 

 
13

2. ATM fees assessed to cardholder

Do not include ATM operator fees for transactions at 

nonproprietary (out-of-network) ATMs. 

If reporting in aggregate, respond only to question 2c.

2a. Were ATM fees assessed to cardholders in 

2011? 

 If no, proceed to question 3a. 

Yes

[ ] 

No 

[ ] 

2a.1 Were these ATM fees subject to 

government-imposed restrictions?

Yes

[ ] 

No 

[ ] 

Please describe government-imposed restrictions: 

2b. Were any of these ATM fees waived or for 

some other reason not assessed to 

cardholders in 2011? 

If no, proceed to 2c.

Yes

[ ] 

No 

[ ] 

Number

2b.1 Total number of ATM fees waived or for 

some other reason not assessed to 

cardholders. 

 

2b.2 Was the number of ATM 

fees waived or for some 

other reason not assessed to 

cardholders in 2b.1 allotted 

to the cardholder monthly, 

per deposit to the card, or 

using some other unit of 

measure? 

Monthly 

[ ] 

Per 

deposit 

to card 

[ ] 

Other 

[ ] 

If other, specify unit of measure: 

 

 
14

Number

2c. Total number of ATM fees assessed to cardholders 

in 2011 

Do not include the number of ATM cash withdrawals for 

which ATM fees were waived or for some other reason not 

assessed to cardholders.

Dollars ($)

2c.1 Minimum ATM fee assessed to 

cardholders in 2011 (per ATM cash 

withdrawal) 

Include only fees greater than $0.00. 

2c.2 Maximum ATM fee assessed to 

cardholders in 2011 (per ATM cash 

withdrawal) 

 

Optional: Please provide a brief description of the fee structure applicable to responses under 2.: 

 
15

3. Over-the-counter at-bank (teller) cash 

withdrawal fees 

If reporting in aggregate, respond only to question 3c.

3a. Were over-the-counter at-bank (teller) 

cash withdrawal fees assessed to 

cardholders in 2011? 

 If no, proceed to question 4a. 

Yes

[ ] 

No 

[ ] 

3a.1 Were these over-the-counter atbank (teller) cash withdrawal 

fees subject to governmentimposed restrictions?

Yes

[ ] 

No 

[ ] 

Please describe government-imposed restrictions: 

3b. Were any of these over-the-counter atbank (teller) cash withdrawal fees

waived or for some other reason not 

assessed to cardholders in 2011? 

If no, proceed to 3c.

Yes

[ ] 

No 

[ ] 

Number

3b.1 Total number of over-the-counter atbank (teller) cash withdrawal fees 

waived or for some other reason not 

assessed to cardholders. 

 

 

3b.2 Was the number of overthe-counter at-bank 

(teller) cash withdrawal 

fees waived or for some 

other reason not assessed in 

3b.1 allotted to the 

cardholder monthly, per 

deposit to the card, or using 

some other unit of measure? 

Monthly 

[ ] 

Per 

deposit 

to card 

[ ] 

Other 

[ ] 

If other, specify unit of measure: 

 
16

Number

3c. Total number of over-the-counter at-bank 

(teller) cash withdrawal fees assessed to 

cardholders in 2011 

Do not include the number of transactions for which the 

over-the-counter at-bank (teller) cash withdrawal fees 

were waived or for some other reason not assessed to 

cardholders.

Dollars ($)

3c.1 Minimum over-the-counter at-bank 

(teller) cash withdrawal fee assessed to 

cardholders in 2011 (per over-the-counter atbank (teller) cash withdrawal) 

Include only fees greater than $0.00. 

3c.2 Maximum over-the-counter at-bank 

(teller) cash withdrawal fee assessed to 

cardholders in 2011 (per over-the-counter atbank (teller) cash withdrawal) 

 

Optional: Please provide a brief description of the fee structure applicable to responses under 3.: 

 
17

4. Account servicing fees 

If reporting in aggregate, respond only to question 4c.

4a. Were account servicing fees assessed 

to cardholders in 2011? 

 If no, proceed to question 5a. 

Yes

[ ] 

No 

[ ] 

4a.1 Were these account servicing 

fees subject to governmentimposed restrictions?

Yes

[ ] 

No 

[ ] 

Please describe government-imposed restrictions: 

4b. Were any of these account servicing

fees waived or for some other reason not 

assessed to cardholders in 2011? 

If no, proceed to 4c.

Yes

[ ] 

No 

[ ] 

Number

4b.1 Total number of account servicing fees

waived or for some other reason not 

assessed to cardholders. 

 

4b.2 Was the number of account 

servicing fees waived or 

for some other reason not 

assessed in 4b.1 allotted to 

the cardholder monthly, per 

deposit to the card, or using 

some other unit of measure? 

Monthly 

[ ] 

Per 

deposit 

to card 

[ ] 

Other 

[ ] 

If other, specify unit of measure: 

 

 
18

Number

4c. Total number of account servicing fees

assessed to cardholders in 2011 

Do not include the number of account servicing activities 

for which account servicing fees were waived or for some 

other reason not assessed to cardholders.

Dollars ($)

4c.1 Minimum account servicing fee

assessed to cardholders in 2011 (per account 

servicing activity) 

Include only fees greater than $0.00. 

4c.2 Maximum account servicing fee

assessed to cardholders in 2011 (per account 

servicing activity) 

 

Optional: Please provide a brief description of the fee structure applicable to responses under 4.: 
19

5. Routine Monthly fees 

If reporting in aggregate, respond only to question 5c.

5a. Were routine monthly fees assessed to 

cardholders in 2011? 

 If no, proceed to question 6a. 

Yes

[ ] 

No 

[ ] 

5a.1 Were these routine monthly

fees subject to governmentimposed restriction?

Yes

[ ] 

No 

[ ] 

Please describe government-imposed restrictions: 

5b. Were any of these routine monthly fees

waived or for some other reason not 

assessed to cardholders in 2011? 

If no, proceed to 5c.

Yes

[ ] 

No 

[ ] 

Number

5b.1 Total number of routine monthly fees 

waived or for some other reason not 

assessed to cardholders. 

 

5b.2 Was the number of routine 

monthly fees waived or for 

some other reason not 

assessed in 5b.1 allotted to 

the cardholder based on 

balance in the account or 

using some other unit of 

measure? 

Balance in 

account 

[ ] 

Other 

[ ] 

If other, specify unit of measure: 

 

 
20

Number

5c. Total number of routine monthly fees assessed 

to cardholders in 2011 

Do not include the number of months for which routine 

monthly fees were waived or for some other reason not 

assessed to cardholders.

Dollars ($)

5c.1 Minimum routine monthly fee assessed 

to cardholders in 2011 (per month) 

Include only monthly fees greater than $0.00. 

5c.2 Maximum routine monthly fee assessed 

to cardholders in 2011 (per month) 

 

Optional: Please provide a brief description of the fee structure applicable to responses under 5.: 

 
21

6. Customer service inquiry fees

If reporting in aggregate, respond only to question 6c.

6a. Were customer service inquiry fees

assessed to cardholders in 2011? 

 If no, proceed to question 7a. 

Yes

[ ] 

No 

[ ] 

6a.1 Were these customer service

inquiry fees subject to 

government-imposed restrictions?

Yes

[ ] 

No 

[ ] 

Please describe government-imposed restrictions: 

6b. Were any of these customer service 

inquiry fees waived or for some other 

reason not assessed to cardholders in 2011? 

If no, proceed to 6c.

Yes

[ ] 

No 

[ ] 

Number

6b.1 Total number of customer service

inquiry fees waived or for some other 

reason not assessed to cardholders. 

 

6b.2 Was the number of 

customer service 

inquiry fees waived or for 

some other reason not 

assessed in 6b.1 allotted to 

the cardholder monthly, per 

deposit to the card, or using 

some other unit of measure? 

Monthly 

[ ] 

Per 

deposit 

to card 

[ ] 

Other 

[ ] 

If other, specify unit of measure: 

 

 
22

Number

6c. Total number of customer service inquiry fees 

assessed to cardholders in 2011 

Do not include the number of customer service inquiries 

for which customer service inquiry fees were waived or for 

some other reason not assessed to cardholders.

Dollars ($)

6c.1 Minimum customer service inquiry fee

assessed to cardholders in 2011 (per customer 

service inquiry) 

Include only fees greater than $0.00. 

6c.2 Maximum customer service inquiry 

fee assessed to cardholders in 2011 (per 

customer service inquiry) 

 

Optional: Please provide a brief description of the fee structure applicable to responses under 6.: 

 
23

7. Penalty fees 

If reporting in aggregate, respond only to question 7c.

7a. Were penalty fees assessed to 

cardholders in 2011? 

 If no, proceed to question 8a. 

Yes

[ ] 

No 

[ ] 

7a.1 Were these penalty fees subject 

to government-imposed restrictions?

Yes

[ ] 

No 

[ ] 

Please describe government-imposed restrictions: 

7b. Were any of these penalty fees waived or 

for some other reason not assessed in 2011? 

If no, proceed to 7c.

Yes

[ ] 

No 

[ ] 

Number

7b.1 Total number of penalty fees waived or for 

some other reason not assessed to 

cardholders. 

 

7b.2 Was the number of penalty 

fees waived or for some 

other reason not assessed in 

7b.1 allotted to the 

cardholder annually or using 

some other unit of measure? 

Annually 

[ ] 

Other 

[ ] 

 

If other, specify unit of measure: 

 

 
24

Number

7c. Total number of penalty fees assessed in 2011 

Do not include the number of penalty incidents for which 

penalty fees were waived or for some other reason not 

assessed to cardholders.

Dollars ($)

7c.1 Minimum penalty fee assessed to 

cardholders in 2011 (per penalty incident) 

Include only fees greater than $0.00. 

7c.2 Maximum penalty fee assessed to 

cardholders in 2011 (per penalty incident) 

 

Optional: Please provide a brief description of the fee structure applicable to responses under 7.: 

 
25

8. Overdraft fees 

If reporting in aggregate, respond only to question 8c.

8a. Were overdraft fees assessed to 

cardholders in 2011? 

 If no, proceed to question 9a. 

Yes

[ ] 

No 

[ ] 

8a.1 Were these overdraft fees

subject to government-imposed 

restrictions?

Yes

[ ] 

No 

[ ] 

Please describe government-imposed restrictions: 

8b. Were any of these overdraft fees waived 

or for some other reason not assessed to 

cardholders in 2011? 

If no, proceed to 8c.

Yes

[ ] 

No 

[ ] 

Number

8b.1 Total number of overdraft fees waived or 

for some other reason not assessed to 

cardholders. 

 

8b.2 Was the number of 

overdraft fees waived or 

for some other reason not 

assessed in 8b.1 allotted to 

the cardholder annaully or 

using some other unit of 

measure? 

Annually [ 

] 

Other 

[ ] 

If other, specify unit of measure: 

 

 
26

Number

8c. Total number of overdraft fees assessed to 

cardholders in 2011 

Do not include the number of overdrafts for which 

overdraft fees were waived or for some other reason not 

assessed to cardholders.

Dollars ($)

8c.1 Minimum overdraft fee assessed to 

cardholders in 2011 (per overdraft) 

Include only fees greater than $0.00. 

8c.2 Maximum overdraft fee assessed to 

cardholders in 2011 (per overdraft) 

 

Optional: Please provide a brief description of the fee structure applicable to responses under 8.: 

 
27

9. Other fees assessed to cardholder (not 

enumerated in other fee categories)

If reporting in aggregate, respond only to question 9c.

9a. Were other fees assessed to cardholders 

in 2011? 

 If no, skip remaining questions in this 

section.

Yes

[ ] 

No 

[ ] 

9a.1 Were these other fees subject to 

government-imposed restrictions?

Yes

[ ] 

No 

[ ] 

Please describe government-imposed restrictions: 

9b. Were any of these other fees waived or for 

some other reason not assessed to 

cardholders in 2011? 

If no, proceed to 9c.

Yes

[ ] 

No 

[ ] 

Number

9b.1 Total number of other fees waived or for 

some other reason not assessed to 

cardholders. 

 

9b.2 Was the number of other 

fees waived or for some 

other reason not assessed in 

9b.1 allotted to the 

cardholder monthly, per 

deposit to the card, or using 

some other unit of measure? 

Monthly 

[ ] 

Per 

deposit 

to card 

[ ] 

Other 

[ ] 

If other, specify unit of measure: 

 

 
28

Number

9c. Total number of other fees assessed in 2011 

Do not include the number of other fee actions for which 

other fees were waived or for some other reason not 

assessed.

Dollars ($)

9c.1 Minimum other fee assessed to 

cardholders in 2011 (per other fee action) 

Include only fees greater than $0.00. 

9c.2 Maximum other fee assessed to 

cardholders in 2011 (per other fee action) 

 

Optional: Please provide a brief description of the fee structure applicable to responses under 9.: 

 
29

Glossary of Terms 

Account servicing fee: Fee assessed to a government-administered, general-use prepaid 

cardholder that includes allowing the account balance to fall below a certain amount, initiating on-line 

bill payment transactions (including fees for individual or recurring payments, proof of payment 

requests, research requests, stop payment requests and returned items), transferring funds from the 

general-use prepaid card to a bank account, converting currency, initiating a cash withdrawal at a 

money service transmitter, requesting standard or expedited card replacement, or requesting check 

issuance. 

ATM fee: Fee assessed to a government-administered, general-use prepaid cardholder for proprietary 

(in-network) or non-proprietary (out-of-network) cash withdrawals at an ATM. 

Cardholder: Individual, household, or other category used for issuing a general-use prepaid card in a 

government-administered payment program. 

Customer service inquiry fee: Fee assessed to a government-administered, general-use prepaid 

cardholder that includes checking the available balance or recent activity on a card via an ATM, an 

automated interactive voice response menu (via landline or cell phone), web-based account access 

or when human interaction between the cardholder and the issuer is involved (such as customer 

service calls to a live representative). 

Dual-message (signature) transaction: Transaction type by which authorization information is 

carried in one message and clearing information is carried in a separate message. 

General-use prepaid card: A card or other payment code or device that is (1) issued on a prepaid 

basis in a specified amount, whether or not that amount may be increased or reloaded, in exchange 

for payment and (2) redeemable upon presentation at multiple unaffiliated merchants for goods or 

services. For the purposes of this survey, this definition applies to card programs, which include, but 

are not limited to, federal benefits (such as Social Security Administration, Supplemental Security 

Income, and Veterans Administration), electronic benefit transfer (such as SNAP), cash assistance 

(such as Temporary Assistance to Needy Families and the Heating and Energy Assistance Program), 

payroll, child support, reimbursements, disaster relief, and petty cash. In addition, the funds related 

to these card programs may be loaded directly onto the card, into an account associated with the 

card, or set aside in some other manner for the benefit of the cardholder. 

Government-administered payment program: A program is considered governmentadministered regardless of whether a federal, state, or local government agency operates the 

program or outsources some or all functions to third parties so long as the program is operated on 

behalf of the government agency. In addition, a program may be government-administered even if a 

federal, state, or local government agency is not the source of funds for the program it administers. 

For example, child support programs are government-administered programs even though a federal, 

state, or local government agency is not the source of the funds. In addition, to the extent Health 

Savings Account, Flexible Spending Account, and Health Reimbursement Arrangement accounts are 

offered in connection with a person's employment and administered by or on behalf of a government 

employer, such accounts are considered government-administered payment programs. Jury duty 

payment programs administered by federal, state, or local governments, including courts, are also 

considered government-administered payment programs. Further, local government-administered 

payment programs would include programs administered by tribal governments. 

Government-imposed restrictions: Requirements imposed by a federal, state or local 

government agency restricting or limiting an issuer from assessing certain fees to general-use 

prepaid cardholders in government-administered payment programs. An example might include a 
30

government agency requiring an issuer to provide the first ATM cash withdrawal at no charge to the 

cardholder. 

Jurisdiction: Geographic area in which government-administered, general-use prepaid cards have 

been issued (such as nationally, specific state, county, or municipality). 

Nonproprietary (out-of-network) ATM: An ATM machine that is not owned by, operated 

exclusively for, or operated by the card issuing depository institution, or is not part of a network with 

which the card issuing depository institution is a member such that ATM use is treated as if the ATM 

machine is proprietary. 

Other fee: Any fee not included in other fee definitions that are assessed to a governmentadministered, general-use prepaid cardholder. 

Overdraft fee: Fee assessed to a government-administered, general-use prepaid cardholder for a 

negative balance (a transaction that was paid despite insufficient funds on the card) or a denied 

transaction (a transaction that was denied for insufficient funds). 

Over-the-counter at-bank (teller) cash withdrawal fee: Fee assessed to a governmentadministered, general use prepaid cardholder for initiating a cash withdrawal at a bank teller location. 

Penalty fee: Fee assessed to a government-administered, general-use prepaid cardholder for the 

infraction of an issuer’s rule(s) or policy/policies. Examples of penalty fees include, daily limit fees 

(circumstances where a cardholder exceeded the transaction amount allowed on a daily basis), 

inactivity fees (fees assessed after a period of time (days or months) without deposit, purchase, 

withdrawal, or other transaction activity), or account termination fees. Do not include overdraft fees. 

Purchase transaction fee: Fee assessed to a government-administered, general use prepaid 

cardholder for routine usage of the card for purchase transactions. Examples of routine transaction 

fees include fees assessed for card usage at the point-of-service (purchase). 

Routine Monthly fee: Fee assessed to a government-administered, general-use prepaid cardholder, 

on a monthly basis, for general maintenance of the card. 

Settled purchase transaction: A prepaid card transaction that has been settled. Exclude 

transactions that are pre-authorizations, denials, adjustments, and returns. 

Single-message (PIN) transaction: Transaction type by which authorization and clearing 

information is carried in one message. 

Total interchange fee revenue received: Total value of fees received that are established, 

charged, or received by a payment card network and paid by a merchant or an acquirer for the 

purpose of compensating an issuer for its involvement in the debit card transaction. 

United States: The states, territories, and possessions of the U.S., the District of Columbia, the 

Commonwealth of Puerto Rico, or any political subdivision of any of the foregoing. 
1

FR 3063b 

OMB No. 7100-0343 

Approval expires December 31, 2014 

GOVERNMENT-ISSUED, GENERAL-USE 

PREPAID CARD SURVEY

Government Survey 

Survey Period: 

Calendar Year 2011 
2

 

General Instructions 

About this Survey 

The Board is required to report annually to the Congress on the prevalence of the use of general-use 

prepaid cards in federal, state, or local government-administered payment programs, and the interchange 

fees and cardholder fees charged with respect to the use of such general-use prepaid cards. [15 U.S.C. 

1693o-2] The information requested in this survey will be used as input to this report. 

Your Participation 

To achieve the most reliable results, it is important that you respond completely and accurately. Please 

leave no survey item blank. 

The survey should be completed in aggregate for all programs and for each program individually 

administered within your jurisdiction. Sections II through IV should be repeated as many times as needed 

to provide the requested data on each program. 

There are three possible ways to answer a survey question: 

Enter a Value: The actual numeric value of the data element. 

Enter a Zero: When the calculated value equals zero. Please do not enter a non-numeric 

value, e.g. “NA” or “NR,” when the value equals zero. 

Enter “NR” (Not Reported): If your government agency engages in the activity of the type being 

measured but you are unable to report a figure that reflects that activity. 

Please do not enter “NA.” 

If for any reason you cannot provide complete data or you have questions please contact 

Jennifer Williams at 202-452-2446 or e-mail debit.card.surveys@frb.gov for assistance. 

The survey will be made available online at

https://www.federalreserve.gov/debitcardsurveys. 

Please complete the survey by April 16, 2012. 

Response Confidentiality and Burden 

The Federal Reserve Board does not regard the individual organization information provided by each 

respondent as confidential. 

 

Public reporting burden for this collection of information is estimated to be 15 hours per response, 

including the time to gather data in the required form and to review instructions and complete the 

information collection. Send comments regarding this burden estimate or any other aspect of this 

collection of information, including suggestions for reducing the burden, to Secretary, Board of Governors 

of the Federal Reserve System, 20th and C Streets, N.W., Washington, D.C. 20551, or via email to 

regs.comments@frb.gov; and to the Office of Management and Budget, Paperwork Reduction Project 

(7100-to be assigned), Washington, D.C. 20503. The Federal Reserve may not conduct or sponsor, and 

an organization (or a person) is not required to respond to, a collection of information unless it displays a 

currently valid OMB control number. 

 
3

Section I: Respondent Information 

1. Name of government agency/agencies covered in this response 

2. Contact person(s) by section of the survey for which responsible 

Name Email 

Section Phone 

Name Email 

Section Phone 

Name Email 

Section Phone 

 
4

Section II: Government-Administered, General-Use 

Prepaid Card Program Information 

Please enter totals only for programs related to general-use prepaid cards linked to U.S.-domiciled accounts 

involving a merchant located in the United States during the calendar year (CY) 2011. 

Provide totals in every section aggregating all programs covered by this agency. Then repeat sections II 

through IV (as many times as needed) to provide totals for each individual program that your agency 

administers (as listed in Question 1 below).

Include: All general-use prepaid card programs administered by a federal, state, or local government 

agency. Examples of such general-use card programs include, but are not limited to, federal benefit 

programs (such as Social Security Administration, Supplemental Security Income, and Veterans 

Administration), electronic benefit transfer programs (such as the Supplemental Nutrition Assistance 

Program (SNAP)), cash assistance programs (such as Temporary Assistance to Needy Families and 

the Heating and Energy Assistance Program), payroll programs, child support programs, 

reimbursement programs, disaster relief programs, and petty cash programs. 

Specific instructions for Section II when reporting in aggregate: 

 List the name of each individual program covered in 1. 

Check all programs that apply in 2. 

List all relevant jurisdictions in 3. 

List all relevant sponsoring government agencies that apply in 4. 

List all relevant card-issuing banks in 5. 

Provide a description of each payment program covered in 6. 

Report the total number of recipients receiving prepaid card payments for all programs in 7. and specify 

all relevant categories of recipients. 

Report the total number of recipients receiving payments (all payment methods, e.g., check, automated 

clearing house, general-use prepaid card) for all programs in 8.

1. Name of government-administered payment program(s) covered in this response 

2. Does this response cover federal, state, or 

local program(s)? 

For reporting totals for an individual program, check 

only one. 

Federal

[ ] 

 

 

State 

[ ] 

 

Local

[ ] 

3. Jurisdiction(s) 

Geographic area in which the government-administered, general-use prepaid cards have been issued (e.g. 

nationally, specific state(s), county/counties, municipality/municipalities). 

4. Sponsoring government agency/agencies 

Government agency administering the general-use prepaid card program 
5

5. Card-issuing bank(s)

6. Description of government-administered payment program 

Please provide the type of program (e.g. medical benefit, unemployment insurance, child support, SNAP, inkind assistance). 

 Number

7. Recipients receiving payments on governmentadministered, general-use prepaid cards as of 

December 31, 2011 

Count each card, individual, household, or other category only 

once.

Please specify how recipients are counted: 

For reporting totals for an individual program, check 

only one. 

Individual

[ ] 

Household 

[ ] 

Other

[ ] 

 If other, please specify: 

 

Number 

8. All Recipients receiving payments (all payment 

methods, e.g., check, automated clearing house, generaluse prepaid card) as of December 31, 2011

Section III: Government-Administered Payment Cards 

 Number

1. Government-administered, general-use prepaid 

cards outstanding as of December 31, 2011

1a. Government-administered, general-use prepaid cards 

on which cardholders receive benefits or 

payments from multiple programs as of 

December 31, 2011 

Please list all programs covered within this response for which 1a. applies:
6

Section IV: Funding 

Value ($)

1. Funds loaded onto government-administered, 

general-use prepaid cards in 2011 

2. All funds paid (all payment methods, e.g., check, 

automated clearing house, general-use prepaid card) in 

2011

 
7

Glossary of Terms 

Government-administered payment program: A program is considered governmentadministered regardless of whether a federal, state, or local government agency operates the 

program or outsources some or all functions to third parties so long as the program is operated on 

behalf of the government agency. In addition, a program may be government-administered even if a 

federal, state, or local government agency is not the source of funds for the program it administers. 

For example, child support programs are government-administered programs even though a federal, 

state, or local government agency is not the source of the funds. In addition, to the extent Health 

Savings Accounts, Flexible Spending Accounts, and Health Reimbursement Arrangement accounts 

are offered in connection with a person's employment and administered by or on behalf of a 

government employer, such accounts are considered government-administered payment programs. 

Jury duty payment programs administered by federal, state, or local governments, including courts, 

are also considered government-administered payment programs. Further, local governmentadministered payment programs would include programs administered by tribal governments. 

General-use prepaid card: A card or other payment code or device that is (1) issued on a prepaid 

basis in a specified amount, whether or not that amount may be increased or reloaded, in exchange 

for payment and (2) redeemable upon presentation at multiple unaffiliated merchants for goods or 

services. For the purposes of this survey, this definition applies to card programs, which include, but 

are not limited to, federal benefits (such as Social Security Administration, Supplemental Security 

Income, and Veterans Administration), electronic benefit transfer (such as SNAP), cash assistance 

(such as Temporary Assistance to Needy Families and the Heating and Energy Assistance Program), 

payroll, child support, reimbursements, disaster relief, and petty cash. In addition, the funds related 

to these card programs may be loaded directly onto the card, into an account associated with the 

card, or set aside in some other manner for the benefit of the cardholder. 

Jurisdiction: Geographic area in which government-administered, general-use prepaid cards have 

been issued (such as nationally, specific state, county, or municipality). 

United States: The states, territories, and possessions of the U.S., the District of Columbia, the 

Commonwealth of Puerto Rico, or any political subdivision of any of the foregoing.