OMB control number
Accounts Receivable Forms for Debt Repayment
OMB 1530-0075 · TREAS/FISCAL.
OMB 1530-0075
The principal purpose for gathering this information is to evaluate a debtor’s ability to pay their debt and to obtain the debtor’s ACH payment information so recurring electronic payments can be set up to pay their debt.
The latest form for Accounts Receivable Forms for Debt Repayment expires 2029-06-30 and is listed under ICR 202511-1530-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form FS Form 123 Financial Statement of Debtor | Form and Instruction |
| Form FS Form 122 Request for Recurring Electronic Payments | Form and Instruction |
 1530-0075 Supporting Statement Debt Collection Forms 2025.docx | Supporting Statement A |
 Financial Statement of Debtor |
Form and Instruction |
| Financial Statement of Debtor |
Form and Instruction |
| Request for Recurring Electronic Payments |
Form and Instruction |
| Request for Recurring Electronic Payments |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202511-1530-001 | Revision of a currently approved collection | 2026-02-27 | ||
| 202208-1530-001 | New collection (Request for a new OMB Control Number) | 2022-11-16 | Approved without change |
OMB Details
Request for Recurring Electronic Payments
Federal Enterprise Architecture: General Government - Central Fiscal Operations
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form FS Form 122 | Request for Recurring Electronic Payments | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.