View RCF - OIRA Conclusion

Title: Form RD 400-4, "Assurance Agreement"

Type of RCF: RCF New
OIRA Conclusion Action: Approved	Conclusion Date: 07/16/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/16/2025
Terms of Clearance:

Description of Agency Usage: (ICR OMB #0570-0065) - Form RD 400-4, "Assurance Agreement" (OMB No. 0575-0201). All applicants and recipients are required to complete this form to comply with Civil Rights Acts and laws.

Authorizing Statute(s): None

Annual Cost to Federal Government:
Agency Contact: Pamela Bennett 202 720-9639 pamela.bennett@usda.gov

Common Form Information Collections (IC) in this RCF:

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Assurance Agreement		9	2	0	Form	Form RD 400-4	Assurance Agreement

RCF Summary of Burden:

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	9	9
Annual Time Burden (Hours)	2	2
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The agency is requesting to use the form which will result in a program change of 2 burden hours.