Information Collection Request

Repayment of Debt

ICR 202507-3220-007 · OMB 3220-0169 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form G-421F (04-20) Repayment by Credit Card - Current Form Unchanged Available
Form G-421F (04-20) Repayment by Debit Card - (Current) Form Unchanged Available
3220-0169_Final.docx Supporting Statement A Uploaded 2026-05-28 Available
Form DRL-145 (12-17).pdf Supplementary Document Uploaded 2017-12-28 Available
Form DR-422B (02-18).pdf Supplementary Document Uploaded 2023-03-21 Available
Form DR-422A (02-18).pdf Supplementary Document Uploaded 2023-03-21 Available
Form DRL-145 (07-16).pdf Supplementary Document Uploaded 2016-08-04 Available
Form SSA-714 (07-05).pdf Supplementary Document Uploaded 2016-06-08 Available
Form G-66BA (03-13).pdf Supplementary Document Uploaded 2016-06-08 Available
DR-422C (09-19).pdf Supplementary Document Uploaded 2023-03-21 Available
Form G-421 (02-18).pdf Supplementary Document Uploaded 2023-03-21 Available
G-66B (02-03).pdf Supplementary Document Uploaded 2006-09-29 Available
G-66 (02-03).pdf Supplementary Document Uploaded 2006-09-29 Available
Form G-66A (03-13).pdf Supplementary Document Uploaded 2016-06-08 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
45464 Repayment by Credit Card Form UnchangedRepayment by Credit Card - Current
33968 Repayment by Credit Card Form UnchangedRepayment by Debit Card - (Current)

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 06/30/2026
535 535
45 45
0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Repayment by Credit Card G-421F (04-20)
Repayment by Credit Card G-421F (04-20)

table that charts list of burden
  Total Request 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 535 535 0 0 0 0
Annual Time Burden (Hours) 45 45 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No