Information Collection

Mutual and Self-Help Housing - State, Local, and Tribal

IC 180297 under ICR 200705-0575-001 · OMB 0575-0191.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD-1047 Mutual and Self-Help Housing - State, Local, and Tribal	Form
AD-1047 Certification Regarding Debarment, Suspension, and Other AD1047-F-01-92.pdf	Form
AD-1049 CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS AD1049-F-05-90.pdf	Form

IC Title:

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 3551

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	AD-1047	Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions	AD1047-F-01-92.pdf		Yes	No	Fillable Printable
Form	AD-1049	CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS) ALTERNATIVE I - FOR GRANTEES OTHER THAN INDIVIDUALS	AD1049-F-05-90.pdf		Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 23

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	407	407
Annual IC Time Burden (Hours)	1,870	1,870
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.