Request for Reimbursement/Record of Electronic Payment

Land and Water Conservation Fund State Assistance Program, 54 USC §200305

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1024-0031 can be found here:

Documents and Forms

Document Name Document Type
Form 10-905 Request for Reimbursement/Record of Electronic Payment Form
10-905 Record of Electronic Payment 10-905 LWCF Record of Electronic Payment 09192016.xlsx www.nps.gov/ncrc/programs/lwcf/pub.htm Form

Information Collection (IC) Details

IC Title:	Request for Reimbursement/Record of Electronic Payment	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	10-905	Record of Electronic Payment	10-905 LWCF Record of Electronic Payment 09192016.xlsx	http://www.nps.gov/ncrc/programs/lwcf/pub.htm	Yes	No	Fillable Printable

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	336	0	336
Annual IC Time Burden (Hours)	336	168	168
Annual IC Cost Burden (Dollars)	0	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.