Voucher and Payment Request Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0014 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Voucher and Payment Request Form Form
1 2007 Revised Voucher 2007p revised voucher.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Voucher and Payment Request Form	Agency IC Tracking Number:	N/A

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	2007 Revised Voucher	2007p revised voucher.doc		Yes	Yes	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	45,000	-24,000	69,000
Annual IC Time Burden (Hours)	3,750	875	2,875
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.