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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Energy Audit and Energy Assistance - State and Local
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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
AD 1047
Certification Regarding Debarment, Suspension, and Other Responsibility Matters � Primary Covered Transactions
AD1047-F-01-92.pdf
Yes
Yes
Fillable Printable
Form
AD 1048
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion � Lower Tier Covered Transactions
AD1048-F-01-92.pdf
Yes
Yes
Fillable Printable
Form
AD 1049
Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I
AD1049-F-05-90.pdf
Yes
Yes
Fillable Printable
Form
RD 1940-1
Request for Obligation of Funds
RD1940-0001_080700V01.pdf
Yes
Yes
Fillable Printable
Form
RD 400-4
Assurance Agreement
0400-04.pdf
Yes
Yes
Fillable Printable
Form
RD 1942-46
Letter of Intent
1942-46.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Energy
Subfunction:
Energy Production
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
329
0
329
0
0
0
Annual IC Time Burden (Hours)
445
0
445
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Application for Federal Assistance
424_20090131[1].doc
03/11/2009
Financial Status Report
sf269[1].pdf
03/11/2009
Request for Adance or Reimbursement
sf270[1].pdf
03/11/2009
Budget Information - Non-Construction Programs
SF424A-V1[1].0.pdf
03/11/2009
Assurances - Non-Construction Programs
SF424B[1].pdf
03/11/2009
Disclosure of Lobbying Activities
sflllin[1].pdf
03/11/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.