Information Collection

Recipient Payment Information Form (for eligible revenue sharing counties)

IC 256099 under ICR 202303-1505-002 · OMB 1505-0276.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0276 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Recipient Payment Information Form (for eligible revenue sharing counties)	Form and Instruction
LATCF Recipient Payment Information LATCF Recipient Payment Information_v2.docx	Form and Instruction
LATCF Recipient Payment Information LATCF Recipient Payment Information_v2.docx	Form and Instruction

IC Title:

Recipient Payment Information Form (for eligible revenue sharing counties)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	N/A	LATCF Recipient Payment Information	LATCF Recipient Payment Information_v2.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,103

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,103	2,103
Annual IC Time Burden (Hours)	2,103	2,103
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.