View Information Collection (IC)

View Information Collection (IC)

IC Title:	7 CFR 1776, "Household Water Well System Grant Program"	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 1776

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-Primary	AD_1047-V1.0.pdf	https://www.ocio.usda.gov/document/ad-1047	Yes	No	Fillable Printable
Form	AD-1048	Certification Regarding Debarment	AD_1048-V1.0.pdf	https://www.ocio.usda.gov/document/ad-1048	Yes	No	Fillable Printable
Form	AD-1049	Certification Regarding Drug-Free Workplace Requirements	AD_1049_2_0-V2.0.pdf	https://www.ocio.usda.gov/document/ad-1049	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: 0575-S201810-001	FR Citation: 84 FR 21315

Number of Respondents: 6	Number of Respondents for Small Entity: 5

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

	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	130	0	0	-16	0	146
Annual IC Time Burden (Hours)	666	0	0	-104	0	770
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.