REQUEST FOR ADVANCE OR REIMBURSEMENT

ICR 198111-0990-002

OMB: 0990-0059

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
116547 Migrated
ICR Details
0990-0059 198111-0990-002
Historical Active 198012-0990-001
HHS/HHSDM
REQUEST FOR ADVANCE OR REIMBURSEMENT
Extension without change of a currently approved collection   No
Regular
Approved without change 12/11/1981
Retrieve Notice of Action (NOA) 11/20/1981
  Inventory as of this Action Requested Previously Approved
12/31/1984 12/31/1984 12/31/1981
83,964 0 83,964
20,991 0 20,991
0 0 0

THIS IS A CASH REQUEST FORM. IT REQUIRES RECIPIENTS TO SCHEDULE FROM ONE TO FOUR ADVANCES WITHIN THE MONTH TO CORRESPOND TO IMMEDIATE DISBURSEMENT NEEDS. IT ALSO REQUIRES THE RECIPIENT TO REPORT THE ACTUAL CASH ON HAND AS OF THE REQUEST DATE.

None
None


No

1
IC Title Form No. Form Name
REQUEST FOR ADVANCE OR REIMBURSEMENT OS-21-81

  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 83,964 83,964 0 0 0 0
Annual Time Burden (Hours) 20,991 20,991 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/20/1981


© 2024 OMB.report | Privacy Policy