Information Collection

4284-b

IC 46673 under ICR 200701-0570-002 · OMB 0570-0053.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RD 4284-01 4284-B	Form
RD 4284-01 Grant Agreement 4284-01.pdf	Form
SF- 424 Appl Fed Assistance.pdf SF 424 Application	IC Document
SF - 424a Bdgt Info Non-Constr Prog..pdf SF 424A Budget Info Non-construction	IC Document
SF -424b Assurances - Non-Constr Prog..pdf SF 424B Assurances Non-constructions	IC Document
SF - 269 Financial Status Rpt - Long form.pdf SF 269 Financial Status Report (Long Form)	IC Document
SF 269a Financial Status Rept..pdf SF 269A Financial Status Report (Short Form)	IC Document
SF - 270 Request for Advcmt or Reimb.pdf SF 270 Req f/Advance or Reimbursement	IC Document

IC Title:

4284-B

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 4284, subpart B (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	RD 4284-01	Grant Agreement	4284-01.pdf		Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,160	8,160
Annual IC Time Burden (Hours)	53,235	53,235
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SF 424 Application	SF- 424 Appl Fed Assistance.pdf	04/23/2007
SF 424A Budget Info Non-construction	SF - 424a Bdgt Info Non-Constr Prog..pdf	04/23/2007
SF 424B Assurances Non-constructions	SF -424b Assurances - Non-Constr Prog..pdf	04/23/2007
SF 269 Financial Status Report (Long Form)	SF - 269 Financial Status Rpt - Long form.pdf	04/23/2007
SF 269A Financial Status Report (Short Form)	SF 269a Financial Status Rept..pdf	04/23/2007
SF 270 Req f/Advance or Reimbursement	SF - 270 Request for Advcmt or Reimb.pdf	04/23/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.