Information Collection

Payment Request Web Form

IC 245343 under ICR 202402-3137-003 · OMB 3137-0124.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 1 Payment Request Web Form	Form
IMLS 3137-0124 Payment Request Form Instructions 20240131.pdf	Instruction
IMLS 3137-0124 Payment Request Form Instructions 20240131.pdf	Instruction
Form 1 Request for Advance or Reimbursement Web Form IMLS 3137-0124 Payment Request Form Interface 20240131.docx grants.imls.gov/Reach/	Form
Form 1 Request for Advance or Reimbursement Web Form IMLS 3137-0124 Payment Request Form Interface 20240131.docx grants.imls.gov/Reach/	Form
reach_how_to_submit_a_payment_request.pdf How to Submit a Payment Request in eGMS Reach	IC Document
reach_how_to_submit_a_payment_request.pdf How to Submit a Payment Request in eGMS Reach	IC Document
Payment Request Burden Estimate 20201215.xlsx Burden Estimate	IC Document
Payment Request Burden Estimate 20201215.xlsx Burden Estimate	IC Document
IMLS Request for Advance or Reimb Web Form 20200108.docx Payment Request Web Form	IC Document
IMLS Request for Advance or Reimb Web Form 20200108.docx Payment Request Web Form	IC Document
IMLS 3137-0124 Payment Request Form Burden Estimate 20240201.xlsx Burden Estimate FY2024	IC Document
IMLS 3137-0124 Payment Request Form Burden Estimate 20240201.xlsx Burden Estimate FY2024	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	Form 1	Request for Advance or Reimbursement Web Form	IMLS 3137-0124 Payment Request Form Interface 20240131.docx	https://grants.imls.gov/Reach/	Yes	Yes	Fillable Printable
Instruction			IMLS 3137-0124 Payment Request Form Instructions 20240131.pdf		Yes	Yes	Printable Only

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,000

Number of Respondents for Small Entity: 2,000

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,000	1,000	5,000
Annual IC Time Burden (Hours)	6,000	1,000	5,000
Annual IC Cost Burden (Dollars)	190,800	45,300	145,500

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
How to Submit a Payment Request in eGMS Reach	reach_how_to_submit_a_payment_request.pdf	01/14/2021
Burden Estimate	Payment Request Burden Estimate 20201215.xlsx	01/14/2021
Payment Request Web Form	IMLS Request for Advance or Reimb Web Form 20200108.docx	02/07/2024
Burden Estimate FY2024	IMLS 3137-0124 Payment Request Form Burden Estimate 20240201.xlsx	02/07/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.