Information Collection

Form 14417--Reimbursable Agreement - Non-Federal Entities

IC 203932 under ICR 202511-1545-017 · OMB 1545-2235.

Documents and Forms

Document Name Document Type
Form Form 14417 Reimbursable Agreement--Non-Federal Entities Form 14417--Reimbursable Agreement - Non-Federal Entities Form and Instruction
Form 14417 Reimbursable Agreement--Non-Federal Entities Form 14417 (Rev. 8-2025).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 14417--Reimbursable Agreement - Non-Federal Entities	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Form 14417	Reimbursable Agreement--Non-Federal Entities	Form 14417 (Rev. 8-2025).pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	60	-240	300
Annual IC Time Burden (Hours)	30	-120	150
Annual IC Cost Burden (Dollars)	0	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.

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