Information Collection

Energy Audit and Energy Assistance - Private Sector

IC 188026 under ICR 200902-0570-001 · OMB 0570-0059.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0570-0059 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD 1047 Energy Audit and Energy Assistance - Private Sector	Form
AD 1047 Certification Regarding Debarment, Suspension, and Other AD1047-F-01-92.pdf	Form
AD 1048 Certification Regarding Debarment, Suspension, Ineligibi AD1048-F-01-92.pdf	Form
AD 1049 Certification Regarding Drug-Free Workplace Requirements AD1049-F-05-90.pdf	Form
RD 1940-1 Request for Obligation of Funds RD1940-0001_080700V01.pdf	Form
RD 400-4 Assurance Agreement 0400-04.pdf	Form
RD 1942-46 Letter of Intent RD1942-0046.pdf	Form
424_20090131[1].doc Application for Federal Assistance	IC Document
SF424A-V1[1].0.pdf Budget Information - Non-Construction Programs	IC Document
SF424B[1].pdf Assurances - Non-Construction Programs	IC Document
sflllin[1].pdf Disclosure of Lobbying Activities	IC Document
sf269[1].pdf Financial Status Report	IC Document
sf270[1].pdf Request for Adance or Reimbursement	IC Document

IC Title:

Energy Audit and Energy Assistance - Private Sector

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	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	Yes	Fillable Printable
Form	AD 1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion ? Lower Tier Covered Transactions	AD1048-F-01-92.pdf	Yes	Yes	Fillable Printable
Form	AD 1049	Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I	AD1049-F-05-90.pdf	Yes	Yes	Fillable Printable
Form	RD 1940-1	Request for Obligation of Funds	RD1940-0001_080700V01.pdf	Yes	Yes	Fillable Printable
Form	RD 400-4	Assurance Agreement	0400-04.pdf	Yes	Yes	Fillable Printable
Form	RD 1942-46	Letter of Intent	RD1942-0046.pdf	Yes	Yes	Fillable Printable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 33

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	536	536
Annual IC Time Burden (Hours)	725	725
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Application for Federal Assistance	424_20090131[1].doc	03/11/2009
Budget Information - Non-Construction Programs	SF424A-V1[1].0.pdf	03/11/2009
Assurances - Non-Construction Programs	SF424B[1].pdf	03/11/2009
Disclosure of Lobbying Activities	sflllin[1].pdf	03/11/2009
Financial Status Report	sf269[1].pdf	03/11/2009
Request for Adance or Reimbursement	sf270[1].pdf	03/11/2009

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