Information Collection

Voucher and Payment Request Form

IC 42256 under ICR 201909-3045-003 · OMB 3045-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0014 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Voucher and Payment Request Form	Form and Instruction
1 2016 Voucher and Payment Request Form 2016 Manual voucher May 23 2016 OGC - FINAL - OGC edit.doc www.nationalservice.gov	Form and Instruction

IC Title:

Voucher and Payment Request Form

Agency IC Tracking Number:

N/A

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 and Instruction	1	2016 Voucher and Payment Request Form	2016 Manual voucher May 23 2016 OGC - FINAL - OGC edit.doc	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: System of Records Notice

FR Citation: 67 FR 4395

Number of Respondents: 162,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	162,000	148,800	13,200
Annual IC Time Burden (Hours)	13,500	12,400	1,100
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.