Information Collection

Financial Statement of Debtor

IC 255634 under ICR 202511-1530-001 · OMB 1530-0075.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FS Form 123 Financial Statement of Debtor Financial Statement of Debtor	Form and Instruction
FS Form 123 Financial Statement of Debtor ARS Financial Statement Form.pdf	Form and Instruction

IC Title:

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 and Instruction	FS Form 123				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
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40	0	40
Annual IC Time Burden (Hours)	30	0	30
Annual IC Cost Burden (Dollars)	0	-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.

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