Sample Report

(00)Agency Title (00) Bureau Title (00000) Entity Title(x)Type
Third Quarter 2004

Part I - Status of Receivables
	Number	Dollars
Section A Receivables and Collections (General)

1	Beginning FY Balance	205	547,413
2	New Receivables (+)	135	204,163
3	Accruals (+)		0
4	Collections on Receivables(-)		-111390
	(A) At Agency(-)		-111,000
	(B) At Third Party(-)		-190
	(C) Asset Sales(-)		-200
	(D) Other(-)		0
5	Adjustments(+ or -)	1	-74,217
	(A) Reclassified/Adjusted Amounts (+ or -)		-71,217
	(B) Adjustments Due to Sale of Assets (+ or -)		0
	(C) Consolidations (+ or -)		0
6	Amounts Written Off (-)	0	0
	(A) Currently not Collectible(-)	0	0
	(B) Written off an Closed Out(-)	0	0
7	Ending Balance	201	568,969

	(A) Foreign/Sovereign(+)	0	0
	(B) State and Local Government(+)	0	0

8	Rescheduled Debt
	(A) Delinquent(+)	0	0
	(B) Non-Delinquent(+)	0	0
9	Interest & Late Charge(+)		0

Section B
Delinquent Debt by Age (General)

1	Total Delinquencies(+)	79	73,524
	(A) 1-90 Days(+)		8,577
	(B) 91-180 Days(+)		21,145
	(C) 181-365 Days(+)		2,112
	(D) 1-2 Years(+)		18,484
	(E) 2-6 Years(+)		7,800
	(F) 6-10 Years(+)		15,000
	(G) Over 10 Years(+)		406
2	Commercial(+)	79	73,524
3	Consumer(+)	0	0

Foreign/Sovereign Debt(+)

Part II - Debt Management Tool and Technique Performance Data
	Number	Dollars
Section A Delinquent Debt 180 Days or Less (General)

1	Total Delinquencies 1-180 Days(+)		29,772
	(A) In Bankruptcy(+)	1	722
	(B) In Forbearance or In Formal Appeals Process(+)	15	1000
	(C) In Foreclosure(+)	35	2050
	(D) At Private Collection Agencies(+)	3	13000
	(E) At DOJ(+)	100	985
	(F) Eligible for Internal Offset(+)	5	3500
	(G) In Wage Garnishment(+)	0	0
	(H) At Treasury for Cross Servicing(+)	80	5000
	(I) At Treasury for Offset(+)	35	3500
	(J) At Agency(+)	55	3315
	(K) Other - must footnote(+)	0	0

Section B
Debt Eligible for Referral to Treasury for Offset and Cross-Servicing (General)

1	Debt Eligible for Referral to Treasury for Offset
	(A) Delinquent Debt Over 180 Days and Currently not Collectible		43802
	(B) In Bankruptcy (-)	0-1245	-15000
	(C) Foreign/Sovereign Debt (-)	-55	-2500
	(D) In Forbearance or Formal Appeals Process (-)	0	0
	(E) In Foreclosure (-)	-875	-500
	(F) Other - must footnote (+ or -)	0	0
	(G) Debt Eligible for Referral to Treasury for Offset(+)	1500	25802
	(H) Debt Referred to DOJ/Litigation(-)	0	0
	(I) Debt Eligible for Referral to Offset by Agency	0	0
	(J) Debt Referred to Treasury for Offset(-)	0	0
	(K) Balance of Debt Eligible for Referral by the Agency	0	0
2	Debt Eligible for Referral to Treasury or a Designated Debt Collection Center for Cross-Servicing
	(A) Debt Eligible for Referral to Offset by Agency	1500	25802
	(B) At PCAs (-)	-1	-25
	(C) Eligible for Internal Offset (-)	-55	-1250
	(D) Debt Exempted by Treasury from Cross Servicing(-)	0	0
	(E) Other - must footnote(+ or -)	0	0
	(F) Debt Eligible for Referral to Treasury/Designated Debt Collection Center for Cross-Servicing(+)	1444	24527
	(G) Debt Referred to Treasury for Cross Servicing(-)	0	0
	(H) Balance of Debt Eligible for Referral by the Agency	0	0

Section C
Collections (General)

1	Collections on Delinquent Debt		9999
	(A) By Private Collection Agencies(+)	55	2100
	(B) By Litigation(+)	6	21
	(C) By Internal Offset(+)	24	545
	(D) By Third Party(+)	23	78
	(E) By Asset Sales(+)	0	0
	(F) By Wage Garnishment(+)	0	0
	(G) By Treasury / Designated Debt Collection Center Cross Servicing(+)	7	5
	(H) By Treasury Offset(+)	31	1750
	(I) By Agency(+)	163	5500
	(J) Other - must footnote(+)	0	0

Section D
Debt Disposition (General)

1	Currently not Collectible (Written Off and Not Closed Out)	49	17550
	(A) At Private Collection Agencies(+)	1	50
	(B) At Treasury / Designated Debt Collection Center for Cross Servicing(+)	15	1500
	(C) At Treasury for Offset(+)	33	16000
	(D) Other - must footnote(+)	0	0
2	Reported to IRS on Form 1099-C (Written off and Closed Out)	0	0
3	Disposition of Debts Closed Out by CY for Tax Compliance Purposes
	(A) CNC Reclassified as Closed Out During the Current CY	5	10000
	(B) Total Of CNC Debts Closed Out During Previous CY	10	15000
	(C) Closed Out Debts Not Reported to IRS on 1099-C - must footnote	3	5000

Part III - Footnotes (General)

Part I, Section A, Line 5(A). Reclassified amount = the adjustment to all debts such as monetary adjustments and accounts cancelled cumulative FY to date.

Update Agency Contact Information As Needed

	Supervisor Information		Preparer Information
First Name:	molly	First Name:	lisa
Last Name:	smith	Last Name:	loomer
E-Mail:	msmith@agency.gov	E-Mail:	lloomer@agency.gov
Phone:	202-777-7777	Phone:	202-777-7778
Address1:	777 7th Street, NW	Fax:	202-777-7779
Address2:
Address3:
City:	Washington
State:	DC
Zip Code:	20000