Information Collection

Voucher and Payment Request Form

IC 42256 under ICR 202602-3045-001 · OMB 3045-0014.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2016 Voucher and Payment Request Form Voucher and Payment Request Form	Form and Instruction
1 2016 Voucher and Payment Request Form 2016 Manual voucher May 23 2016 OGC - FINAL - OGC edit.doc www.nationalservice.gov	Form and Instruction

IC Title:

Agency IC Tracking Number:

N/A

Is this a Common Form? No

IC Status: Modified

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	1			www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: CNCS-04-CPO-MPMF - Member Program Management Files

FR Citation: 89 FR 65866

Number of Respondents: 34,385

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 66 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	34,385	0	34,385
Annual IC Time Burden (Hours)	2,865	0	2,865
Annual IC Cost Burden (Dollars)	137,540	17,536	120,004

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.

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