View Information Collection Request (ICR) Package

OMB Control No: 3245-0012	ICR Reference No: 200506-3245-002
Status: Historical Active	Previous ICR Reference No: 200203-3245-003
Agency/Subagency: SBA	Agency Tracking No:
Title: Financial Statement of Debtor
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/20/2005
	Date Received in OIRA: 06/10/2005
Terms of Clearance: 5 U.S.C. 552a(e)(3) requires the agency to: 'inform each individual whom it asks to supply information on the form which it uses to collect the information or on separate form that can be retained by the individual - (A) the authority (whether granted by statute, or by executive order of the President) which authorizes the solicitation of the information and whether disclosure of information is mandatory or voluntary; (B) the principal purpose or purposes for which the information is intended to be used; (C) the routine uses which may be made of the informati published pursuant to paragraph (4)(D) of this subsection (D) the effects on him, if any, of not providing all or part of the requested information. ..' The agency, prior to issuance of this form, should review the Privacy Act statement on its form and ensure that it complies with this requirement. OMB notes that generally an instruction to contact the agency for further information would not satisfy this provision of the statute.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2008	09/30/2008
Responses	5,000	0	0
Time Burden (Hours)	2,500	0	0
Cost Burden (Dollars)	0	0	0

Abstract: The objective of the debt collection activities is to obtain immediate repayment or arrive at a satisfactory arrangement for future repayment of debts owed to the Government. SBA uses the financial information provided by the debtor on Form 770 in making a determination regarding the compromise of such debts and other liquidation proceedings including litigation by the Agency and/or the Department of Justice.

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Financial Statement of Debtor	770

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	5,000	5,000
Annual Time Burden (Hours)	2,500	2,500
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $0

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

View ICR - OIRA Conclusion