Financial Statement of Debtor

ICR 201111-3245-006

OMB: 3245-0012

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2011-11-30
IC Document Collections
IC ID
Document
Title
Status
35588 Modified
ICR Details
3245-0012 201111-3245-006
Historical Active 200810-3245-001
SBA
Financial Statement of Debtor
Revision of a currently approved collection   No
Regular
Approved without change 02/01/2012
Retrieve Notice of Action (NOA) 11/30/2011
  Inventory as of this Action Requested Previously Approved
02/28/2015 36 Months From Approved 01/31/2012
5,000 0 5,000
5,000 0 2,500
0 0 0

The objective of the debt collection activities is to obtain immediate repayment or arrive at a satisfactory arrangement for future repayment of debts owed to the Government. SBA uses the financial information provided by the debtor on Form 770 in making a determination regarding the compromise of such debts and other liquidation proceedings including litigation by the Agency and/or the Department of Justice.

None
None

Not associated with rulemaking

  76 FR 36164 06/21/2011
76 FR 70527 11/14/2011
No

1
IC Title Form No. Form Name
Financial Statement of Debtor SBA FORM 770 FINANCIAL STATEMENT OF DEBTOR

  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 5,000 5,000 0 0 0 0
Annual Time Burden (Hours) 5,000 2,500 0 2,500 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Increase in hours

$0
No
No
No
No
No
Uncollected
Sandra Johnston 202 205-7528 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/30/2011


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