Information Collection

Personal Financial Statement

IC 236767 under ICR 202202-3015-004 · OMB 3015-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3015-0007 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DFC‐005 Personal Financial Statement	Form and Instruction
DFC‐005 Personal Financial Statement DFC-012 Economic Questionnaire.pdf	Form and Instruction

IC Title:

Personal Financial Statement

Agency IC Tracking Number:

DFCâ005

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	DFCâ005	Personal Financial Statement	DFC-012 Economic Questionnaire.pdf	N/A	Yes	Yes	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

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	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	5,625	5,625

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.