Information Collection

Reimbursement Request

IC 212951 under ICR 201409-3133-001 · OMB 3133-0138.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3133-0138 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Reimbursement Request	Form
Reimbursement Upload Screenshot.png www.cybergrants.com	Other-Reimbursement Screenshot
Student Certification of Business Hours Certification of Business Hours Form_2014 v2.pdf www.cybergrants.com	Form

IC Title:

Reimbursement Request

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 12 CFR 705.10

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	None	Student Certification of Business Hours	Certification of Business Hours Form_2014 v2.pdf	www.cybergrants.com	Yes	Yes	Fillable Printable
Other-Reimbursement Screenshot			Reimbursement Upload Screenshot.png	www.cybergrants.com	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 144

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	144	144
Annual IC Time Burden (Hours)	864	864
Annual IC Cost Burden (Dollars)	25,920	25,920

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.