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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Public/Tribal
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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 Debarrment, etc.
RD AD1047-F-01-92.docx
Yes
No
Fillable Printable
Form
AD-1048
Certification Regarding Debarrment, etc. - Lower Tier
RD AD1048-F-01-92.docx
Yes
No
Fillable Printable
Form
AD-1049
Certification for Drug-Free Workplace
RD AD1049-F-05-90.docx
Yes
No
Fillable Printable
Form
SF 424
Application for Federal Assistance
SF424_2_1-V2.1.pdf
Yes
No
Fillable Printable
Form
RD 400-1
Equal Opportunity Agreement
RD0400-0001.pdf
Yes
No
Fillable Printable
Form
RD 400-4
Assurance Agreement
RD0400-0004.pdf
Yes
No
Fillable Printable
Form
RD 442-2
Statement of Budget, Income and Equity
RD0442-0002.pdf
Yes
No
Fillable Printable
Form
RD 442-3
Balance Sheet
RD0442-0003.pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Community and Regional Development
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
11
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
440
0
0
93
0
347
Annual IC Time Burden (Hours)
556
0
0
137
0
419
Annual IC Cost Burden (Dollars)
0
0
0
0
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.