Recipient Payment Information Form (for eligible revenue sharing counties)

Local Assistance and Tribal Consistency Fund

Documents and Forms

Document Name Document Type
Recipient Payment Information Form (for eligible revenue sharing counties) Form and Instruction
LATCF Recipient Payment Information LATCF Recipient Payment Information_v2.docx Form and Instruction
LATCF Recipient Payment Information LATCF Recipient Payment Information_v2.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Recipient Payment Information Form (for eligible revenue sharing counties)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	N/A	LATCF Recipient Payment Information	LATCF Recipient Payment Information_v2.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,103	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,103	2,103
Annual IC Time Burden (Hours)	2,103	2,103
Annual IC Cost Burden (Dollars)	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.