Information Collection

Application for Payment Request - State and Local Government

IC 203617 under ICR 201208-2060-002 · OMB 2060-0686.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2060-0686 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form in process Application for Payment Request - State and Local Government	Form
Application for Payment Request Instructions.docx	Instruction
in process Application for Payment Request DERA Payment Request Form.pdf	Form

IC Title:

Application for Payment Request - State and Local Government

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	in process	Application for Payment Request	DERA Payment Request Form.pdf		No	No	Paper Only
Instruction			Application for Payment Request Instructions.docx		No	No	Paper Only

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	155	155
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.