View RCF - OIRA Conclusion

Title: 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: This form is executed once by the grantee and outlines the activities they will undertake to ensure compliance with Title VI of the Civil Rights Act of 1964, 7 CFR Part 15, and this notice. (0570-0080)

Authorizing Statute(s): None

Annual Cost to Federal Government:
Agency Contact: Susan Woolard 202 720-9631 susan.woolard@usda.gov

Common Form Information Collections (IC) in this RCF:

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Assurance Agreement		75	19	0	Form	Form RD 400-4	Assurance Agreement

RCF Summary of Burden:

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	75	75
Annual Time Burden (Hours)	19	19
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 19 burden hours.