Information Collection

Request for Reimbursement/Record of Electronic Payment

IC 208705 under ICR 201609-1024-004 · OMB 1024-0031.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.