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OMB Control No: 1122-0030	ICR Reference No: 202602-1122-002
Status: Received in OIRA	Previous ICR Reference No: 202211-1122-002
Agency/Subagency: DOJ/OVW	Agency Tracking No: 1122-0030
Title: Financial Capability Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 02/19/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	02/28/2026
Responses	40	40
Time Burden (Hours)	160	160
Cost Burden (Dollars)	0	0

Annual Cost to Federal Government: $2,240

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. No

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. No

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? No

Agency Contact: Tiffany Watson 202 717-5871 tiffany.watson@usdoj.gov

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