SF-270: Request for Advance or Reimbursement 4040-0012

Forms and Documents

Document	Type	Status	Availability
Form 0348-0004 SF-270: Request for Advance or Reimbursement	Form and Instruction	Removed	Repair queued
Form 4040-0012 4040-0012 SF-270 Request for Advance or Reimbursement Form	Form	New	Repair queued
OMB comments on Grants.gov Standard forms - GrantsGov Response v2.xlsx	Supplementary Document	Uploaded 2016-01-14	Repair queued
4040-0012 SF-270 2015 v1.1.doc	Supporting Statement A	Uploaded 2016-01-14	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
745	SF-270: Request for Advance or Reimbursement	Form and Instruction	Removed
218370	4040-0012 SF-270 Request for Advance or Reimbursement Form	Form	New

ICR Details

OMB Control No: 4040-0012	ICR Reference No: 201509-4040-004
Status: Historical Active	Previous ICR Reference No: 201307-4040-002
Agency/Subagency: EGOV	Agency Tracking No:
Title: SF-270: Request for Advance or Reimbursement 4040-0012
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/15/2016
	Date Received in OIRA: 10/13/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2019	36 Months From Approved	10/31/2013
Responses	100,000	0	100,000
Time Burden (Hours)	100,000	0	100,000
Cost Burden (Dollars)	0	0	0

---

Abstract: Grantees use this form to request funds for all nonconstruction grant programs when letters of credit or predetermined advance methods are not used.

---

Authorizing Statute(s): US Code: 31 USC 503 and 1111 Name of Law: null
   EO: EO 11541 Name/Subject of EO: null
   US Code: 41 USC 405 Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 65969	11/06/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 7603	02/11/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
SF-270: Request for Advance or Reimbursement	0348-0004	SF-270
4040-0012 SF-270 Request for Advance or Reimbursement Form	4040-0012	SF-270 Request for Advance or Reimbursement Form

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	100,000	100,000	0	0	0	0
Annual Time Burden (Hours)	100,000	100,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The SF-270 Request for Advance or Reimbursement Form is a common form used across all Federal grant-making agencies.

---

Annual Cost to Federal Government: $3,900,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  Yes

OIRA authorizes any Agency to begin using a Common Form associated with this ICR automatically after 5 calendar days from the date the agency's RCF including the common form was received in OIRA.

Description/Changes for Common Form Usage:  All Federal grant-making agencies require grant recipients to use this form. This IC shall only report for HHS. All other Federal agencies are responsible for request to use the common form and report their respective burden hours.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title
USDA/AMS	201602-0581-009CF	Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RHS	201605-0575-003CF	Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
DOI/BLM	201606-1004-010CF	BLM - SF 270 - Request for Advance or Reimbursement Common Form Usage	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form, 4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RUS	201701-0572-012CF	Request for Advance or Reimbursement SF-270	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RUS	201701-0572-016CF	Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/AMS	201610-0581-015CF	SF-270 Request for Advance/Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form, 4040-0012 SF-270 Request for Advance or Reimbursement Form, 4040-0012 SF-270 Request for Advance or Reimbursement Form, 4040-0012 SF-270 Request for Advance or Reimbursement Form, 4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RBS	201605-0570-011CF	SF-270 - Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RHS	201607-0575-010CF	SF-270 Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form, 4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RBS	201701-0570-027CF	Request for Advance of Reimbursement SF-270	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RBS	201612-0570-023CF	Request for Advance or Reimbursement - SF-270	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RBS	201612-0570-018CF	SF - 270 Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form, 4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RUS	201701-0572-023CF	Request for Advance or Reimbursement SF-270	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RUS	201707-0572-028CF	SF-270 Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form, 4040-0012 SF-270 Request for Advance or Reimbursement Form, 4040-0012 SF-270 Request for Advance or Reimbursement Form
DOT/FMCSA	201809-2126-006CF	SF-270 Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RUS	201710-0572-036CF	Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/AMS	201901-0581-002CF	SF-270 Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RBS	201802-0570-042CF	SF-270, Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/FS	201802-0596-008CF	SF-270 Request For Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RHS	201810-0575-004CF	SF-270 Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RUS	201804-0572-048CF	Request for Advance or Reimbursement (SF-270)	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form, 4040-0012 SF-270 Request for Advance or Reimbursement Form
USDA/RHS	201804-0575-028CF	SF-270 Request for Advance or Reimbursement	Historical Active	4040-0012 SF-270 Request for Advance or Reimbursement Form

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/13/2015

---