Form 1 Payment Management Reconciliation Instrument

Generic for ACF Program Monitoring Activities

Instrument 1 - Payment Management Reconciliation Instrument.xlsx

Office of Head Start Improper Payment Reviews – Update 2023

OMB: 0970-0558

Document [xlsx]
Download: xlsx | pdf








OMB Control Number: 0970-0558, Expiration Date: 11/30/2023
Period Under Review (PUR) [date]






PMS Disbursement Amount for PUR $















Grant Number Grant Recipient Name Payment Date Check Number/EFT Payment Amount Payee Name Account Type Description Comments












































































































PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF is gathering information to help the Office of Head Start (OHS) examine grant recipient use of federal funds in accordance with the Improper Payments Information Act 2002. Public reporting burden for this collection of information is estimated to average 1 hour per grant recipient, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Title 2, Code of Federal Regulations (CFR), Part 200, Subsection 300, "Statutory and National Policy Requirements" [also codified at Title 45, CFR, Part 75, Subsection 300]). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0558 and the expiration date is 11/30/2023. If you have any comments on this collection of information, please contact [contact].

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