Form 14417--Reimbursable Agreement - Non-Federal Entities

Form 14417 - Reimbursable Agreement-Non-Federal Entities; Form 14417-A - Statistics of Income - User Fee

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.