View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
American Rescue Plan Act Emergency Rural Health Care 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 1940
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Application Submission Non-Form
0575-0200 - Application Submissions- Non Forms.docx
No
Paper Only
Other-Other Reporting Requirements - Non-Form
0575-0200 -Reporting Requirements -Non Forms.docx
No
Paper Only
Form
AD Form 1047
Certification Regarding Debarment, Suspension, and Other Responsibility Matters
AD-1047 Section 508 Compliant.pdf
Yes
Yes
Fillable Printable
Form and Instruction
RD 3570-3
Community Facilities Grant Agreement
RD 3570-3.pdf
Yes
Yes
Fillable Printable
Form and Instruction
RD 442-2
Statement of Budget, Income and Equity
RD 442-2.pdf
Yes
Yes
Fillable Printable
Form and Instruction
RD 442-3
Balance Sheet
RD 442-3.pdf
Yes
Yes
Fillable Printable
Form and Instruction
RD 442-7
Operating Budget
RD 442-7.pdf
Yes
Yes
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:
USDA/RD-1 Current or Prospective Producers or Landowners, Applicants, Borrowers, Grantees, Tenants, and other participants in RD programs.
FR Citation:
84 FR 21315
Number of Respondents:
1,092
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
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
15,389
0
0
-38,911
0
54,300
Annual IC Time Burden (Hours)
71,681
0
0
-129,591
0
201,272
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.