Regulatory Collection Filing

Request for Advance or Reimbursement SF-270

RCF 201701-0572-023CF · Host ICR 201509-4040-004 · OMB 4040-0012

RCF Summary

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	2017-01-31
Conclusion Date	2017-02-06
Agency Tracking No.	0572-0139
Related Links	OMB 4040-0012 · ICR 201509-4040-004 · Retrieve Notice of Action (NOA)

RCF Details

View RCF - OIRA Conclusion

Title: Request for Advance or Reimbursement SF-270

Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/06/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/31/2017
Terms of Clearance:

Description of Agency Usage: Household Water System Program (0572-0139) grant recipients submit this form for disbursement of grant funds and agency approval of the disbursement.

Authorizing Statute(s): None

Annual Cost to Federal Government:
Agency Contact: MaryPat Daskal 202-720-7853 [email protected]

Common Form Information Collections (IC) in this RCF:

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
4040-0012 SF-270 Request for Advance or Reimbursement Form		84	84	0	Form	4040-0012	SF-270 Request for Advance or Reimbursement Form

RCF Summary of Burden:

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	84	84
Annual Time Burden (Hours)	84	84
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.