Information Collection

Form 14417--Reimbursable Agreement - Non-Federal Entities

IC 203932 under ICR 201303-1545-026 · OMB 1545-2235.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2235 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 14417 Form 14417--Reimbursable Agreement - Non-Federal Entities	Form and Instruction
Form 14417 Reimbursable Agreement--Non-Federal Entities Form 14417.pdf	Form and Instruction

IC Title:

Form 14417--Reimbursable Agreement - Non-Federal Entities

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	Form 14417	Reimbursable Agreement--Non-Federal Entities	Form 14417.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	150	150
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.