Regulatory Collection Filing

Request for Advance or Reimbursement

RCF 201701-0572-016CF · Host ICR 201509-4040-004 · OMB 4040-0012

RCF Summary

Request for correction metadata
Host OMB Control No.	4040-0012
Host ICR Reference No.	201509-4040-004
Agency/Subagency	USDA/RUS
Status	Historical Active
Type of RCF	RCF New
OIRA Conclusion Action	Approved without change
Date Received in OIRA	2017-01-09
Conclusion Date	2017-01-12
Agency Tracking No.	0572-0138
Related Links	OMB 4040-0012 · ICR 201509-4040-004 · Retrieve Notice of Action (NOA)

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Title: Request for Advance or Reimbursement

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Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/12/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/09/2017
Terms of Clearance:

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Description of Agency Usage: Revolving Fund Program (0572-0138) grant awardees will submit this form for disbursement of grant funds.

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Authorizing Statute(s): None

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Annual Cost to Federal Government:
Agency Contact: Rebecca Hunt 202 205-3660 [email protected]

Common Form Information Collections (IC) in this RCF:

table that charts list of ICs
IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
4040-0012 SF-270 Request for Advance or Reimbursement Form		36	36	0	Form	4040-0012	SF-270 Request for Advance or Reimbursement Form

RCF Summary of Burden:

table that charts list of burden
	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	36	36
Annual Time Burden (Hours)	36	36
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Common form usage.