Information Collection

Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund

IC 224900 under ICR 201612-3060-014 · OMB 3060-1223.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-1223 can be found here:

Documents and Forms

Document Name Document Type
Form FCC Form 1876 Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund Form
FCC Form 1876 Relocation Reimbursement Form Relocation Reimbursement form Dec 13 2016.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund	Agency IC Tracking Number:	OMD-FO

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 73.3700(e)(7)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC Form 1876	Relocation Reimbursement Form	Relocation Reimbursement form Dec 13 2016.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	3,000	3,000
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.