Information Collection

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

IC 224900 under ICR 201702-3060-016 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form FCC Form 1876 Relocation Reimbursement Form Payment Instructions from the Eligible Entity Seeking Reimbursement from the TV Broadcaster Relocation Fund	Form
Form FCC Form 1876 Relocation Reimbursement Form 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
FCC Form 1876 Relocation Reimbursement Form PDF Relocation Reimbursement form ver 2 ANNOTATED_Changed REED REVISION.pdf	Form

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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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

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	FCC Form 1876				Yes	Yes	Fillable Fileable Signable
Form	FCC Form 1876				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 %

table that charts list of burden
	Approved	Previously Approved
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

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.

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