Information Collection

Debt Collection Financial Statement

IC 21056 under ICR 201404-1660-005 · OMB 1660-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form 127-0-1 Debt Collection Financial Statement	Form
FEMA Form 127-0-1 Debt Collection Financial Statement FEMA Form 127-0-1, 4-18-2014.pdf	Form

IC Title:

Debt Collection Financial Statement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FEMA Form 127-0-1	Debt Collection Financial Statement	FEMA Form 127-0-1, 4-18-2014.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title: DHS/ALL-008 â Department of Homeland Security Accounts Receivable System of Records

FR Citation: 73 FR 61885

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,000	400	1,600
Annual IC Time Burden (Hours)	1,500	300	1,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.