Information Collection

Financial Statement of Debtor

IC 255634 under ICR 202208-1530-001 · OMB 1530-0075.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1530-0075 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FS Form 00123 Financial Statement of Debtor	Form and Instruction
FS Form 00123 Financial Statement of Debtor ARS Financial Statement Form.pdf	Form and Instruction
FS Form 00123 Financial Statement of Debtor ARS Financial Statement Form.pdf	Form and Instruction

IC Title:

Financial Statement of Debtor

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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 and Instruction	FS Form 00123	Financial Statement of Debtor	ARS Financial Statement Form.pdf		Yes	No	Fillable Fileable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	1,044	1,044

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.