Information Collection

Recipient Payment Information Form (for eligible revenue sharing counties)

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.