Debt Collection Financial Statement

Forms and Documents

Document Name	Status
Form FEMA Form 127-0-1 Debt Collection Financial Statement Form	Modified
Supporting Statement OMB Control# 1660-0011, 3-28-2011.doc Supporting Statement A	2011-03-28
Letter of Intent Draft as of 021111.docx Supplementary Document	2011-03-08
Request for Information Household Expense Listing, Final.pdf Supplementary Document	2011-03-08
KR RFI_LTR-020911 Final (Request for Information Letter).pdf Supplementary Document	2011-03-08
1660-0011 30 Day FRN PUBLISHED 2-10-11.pdf Supplementary Document	2011-02-11
(e)(3) FEMA-FF127-0-1 Debt Collection Financial Statement 1660-0011, 20110128.PRIV Final.doc Supplementary Document	2011-03-08
DHS-ALL-008 DHS Accounts Receivable 101708.pdf Supplementary Document	2011-01-31
PTA, FEMA-FF127-0-1, 20110215, PRIV Final.pdf Supplementary Document	2011-03-08
Changes to Collection OMB Control# 1660-0011, 1-29-2011.docx Supplementary Document	2011-01-31
6 CFR Part 11.pdf Supplementary Document	2011-01-31
Published 60-day FRN for OMB Control# 1660-0011, 11-24-2010.pdf Supplementary Document	2011-01-31
Title 31 Sec 3711.pdf Supplementary Document	2008-01-16

IC Document Collections

IC ID	Document Title	Status
21056	Debt Collection Financial Statement Form	Modified

ICR Details

OMB Control No: 1660-0011	ICR Reference No: 201101-1660-007
Status: Historical Active	Previous ICR Reference No: 200801-1660-001
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: Debt Collection Financial Statement
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/06/2011
	Date Received in OIRA: 03/29/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	36 Months From Approved	06/30/2011
Responses	1,600	0	1,000
Time Burden (Hours)	1,200	0	750
Cost Burden (Dollars)	0	0	0

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Abstract: FEMA may request debtors to provide personal financial information on FEMA Form 127-0-1 concerning their current financial position. With this information, FEMA evaluates whether to allow its debtors to pay their FEMA debts under installment repayment agreements and if so, under what terms. FEMA also uses this data to determine whether to compromise, suspend, or completely terminate collection efforts on respondent's debts. This data is also used to locate the debtor's assets if the debts are sent for judicial enforcement.

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Authorizing Statute(s): US Code: 31 USC 3711 Name of Law: Collection and Compromise
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 71718	11/24/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 7577	02/10/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Debt Collection Financial Statement	FEMA Form 127-0-1	Debt Collection Financial Statement

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,600	1,000	0	0	600	0
Annual Time Burden (Hours)	1,200	750	0	0	450	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There has been an increase in the annual hour burden from 750 to 1,200; an increase of 450 hours. This increase is due to the increase in the number (600) of recipients of disaster assistance and the more intensive efforts by FEMA to collect overpayments to those disaster assistance recipients that were provided assistance funds exceeding allowable levels. FEMA is making more effort to provide installment agreements to those with debts to the agency.

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Annual Cost to Federal Government: $131,902

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/29/2011

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