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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
State and Local Governments
Agency IC Tracking Number:
0572
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
Certificate Regarding Debarment
AD1047-F-01-92.docx
http://www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms
Yes
No
Fillable Printable
Form
AD-1048
Certification Regarding Debarment, Suspension and other Responsibility Matters - Lower Tier Covered Transactions.
AD1048-F-01-92.docx
http://www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms
Yes
No
Fillable Printable
Form
AD-1049
Certification Regarding Drug-Free Workplace Requirements (Grrants) Alternative I - for Grantees Other Than Individuals
AD1049-F-05-90.docx
http://www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms
Yes
No
Fillable Printable
Form and Instruction
RD Instruction 1940Q A-1
Certification for Contracts, Grants, and Loans
RD Instruction 1940Q A-1.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 400-1
Equal opportunity Agreement
RD400-1.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 400-4
Assurance Agreement
RD400-4.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form and Instruction
RD 442-2
Statement of Budget, Income and Equity
RD442-2.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 442-3
Balance Sheet
RD442-3.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 442-7
Operating Budget
RD442-7.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 442-22
Opinion of Counsel Regarding Right of Way
RD442-22.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 1942-19
Agreement for Engineering Services
RD1942-19.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 1942-46
Letter of Intent to Meet Conditions
RD1942-46.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form and Instruction
SF 424
Application for Federal Assistance
SF424.pdf
http://apply07.grants.gov/apply/forms/sample/SF424_2_1-V2.1.pdf
Yes
Yes
Fillable Fileable
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:
15
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
724
0
724
0
0
0
Annual IC Time Burden (Hours)
753
0
753
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Budget Information
SF424C_.pdf
12/12/2013
Assurances - Construction Programs
SF424D.pdf
12/12/2013
Disclosure of Lobbying Acitivites
SFLLL.pdf
12/12/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.