Debt Collection Financial Statement

Forms and Documents

Document Name	Status
Form FEMA Form 127-0-1 Debt Collection Financial Statement Form	Modified
Supporting Statement for OMB Control 1660-0011 (Clean).docx Supporting Statement A	2017-08-29
Forms Revision Chart Listing for FEMA Form 127-0-1, 8.29.17.doc Supplementary Document	2017-08-29
FEMA Notice and Demand Letter (NDL).docx Supplementary Document	2017-08-08
Public Law 104-134, CHAPTER 10 DEBT COLLECTION IMPROVEMENTS.pdf Supplementary Document	2017-08-08
Debt Resolution SOP FINAL signed 7.5.16.pdf Supplementary Document	2017-08-08
31 CFR Parts 900 - 904.pdf Supplementary Document	2014-05-13
31 USC 3701.pdf Supplementary Document	2014-05-13
privacy_PIA_fema_nemis_ia_20120629.pdf Supplementary Document	2014-05-13
Letter of Intent (LOI) Template.pdf Supplementary Document	2017-08-08
Request for Information Household Expense Listing, Final.pdf Supplementary Document	2014-06-02
RFI - Request for Info letter.pdf Supplementary Document	2017-08-08
Published 30 Day FRN for OMB Collection 1660-0011, 7-3-2017.pdf Supplementary Document	2017-08-08
(SORN) Federal Register, Volume 73 Issue 202 (Friday, October 17, 2008).mht Supplementary Document	2014-06-02
PTA, FEMA - Form 127-0-1_Debt Collection Financial Statement (OMB 1660-0011), 20140514, PRIV FINAL.pdf Supplementary Document	2014-06-02
Narrative of Changes for OMB Collection 1660-0011.docx Supplementary Document	2017-08-08
6 CFR Part 11, eCFR — Code of Federal Regulations.mht Supplementary Document	2014-05-13
Published 60 Day FRN for OMB Collection 1660-0011, 4-17-2017.pdf Supplementary Document	2017-07-26
Title 31 Sec 3711.pdf Supplementary Document	2008-01-16

IC Document Collections

IC ID	Document Title	Status
21056	Debt Collection Financial Statement Form	Modified

ICR Details

OMB Control No: 1660-0011	ICR Reference No: 201707-1660-002
Status: Historical Active	Previous ICR Reference No: 201404-1660-005
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: Debt Collection Financial Statement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/19/2018
	Date Received in OIRA: 08/31/2017
Terms of Clearance: Given 18 months for noncompliance with GPEA. The agency should investigate ways to provide and receive forms electronically in a secure fashion.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2019	36 Months From Approved	01/31/2018
Responses	300	0	2,000
Time Burden (Hours)	225	0	1,500
Cost Burden (Dollars)	0	0	0

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Abstract: FEMA may request debtors to provide personal financial information on FEMA Form 127-0-1 concerning their current financial position. With this information, FEMA evaluates whether to allow its debtors to pay their FEMA debts under installment repayment agreements and if so, under what terms. FEMA also uses this data to determine whether to compromise, suspend, or completely terminate collection efforts on respondent's debts. This data is also used to locate the debtor's assets if the debts are sent for judicial enforcement.

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Authorizing Statute(s): US Code: 31 USC 3711 Name of Law: Collection and Compromise
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 18154	04/17/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 30881	07/03/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Debt Collection Financial Statement	FEMA Form 127-0-1	Debt Collection Financial Statement

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ICR Summary of Burden

	Total Approved	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	300	2,000	0	0	-1,700	0
Annual Time Burden (Hours)	225	1,500	0	0	-1,275	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: In an effort to collect erroneous overpayments to individuals, FEMA is making a greater effort to provide installment agreements to those with debts to the agency but who are financially unable to pay their debts in a single payment. There have been some changes in the information being collected using FEMA Form 127-0-1. The decrease in the annual hour burden is due to a policy change which enables FEMA Debt Collectors to verbally negotiate payment plans by telephone. The program updated their Standard Operating Procedures (SOP) in 2016, in which the procedures changed and required a little more information. Therefore, changes were made to FEMA Form 127-0-1. See Forms Revision Chart and Debt Resolution SOP.

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Annual Cost to Federal Government: $49,570

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/31/2017

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