Information Collection

SEARCH - Private Sector

IC 188744 under ICR 200903-0572-003 · OMB 0572-0143.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD-1047 Certification Regarding Debarment SEARCH - Private Sector	Form
Form AD-1049 Certification for a Drug-Free Workplace SEARCH - Private Sector	Form
Form AD-1048 Certification Regarding Debarment SEARCH - Private Sector	Form
AD-1047 Certification Regarding Debarment ad1047.pdf www.rurdev.usda.gov/regs//formstoc.html#AD	Form
AD-1049 Certification for a Drug-Free Workplace ad1049.pdf www.rurdev.usda.gov/regs//formstoc.html#AD	Form
AD-1048 Certification Regarding Debarment AD1048.pdf rurdev.usda.gov/regs//formstoc.html#AD	Form

IC Title:

Agency IC Tracking Number:

AD-1047

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.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AD-1047	http://www.rurdev.usda.gov/regs//formstoc.html#AD	Yes	No	Printable Only
Form	AD-1049	http://www.rurdev.usda.gov/regs//formstoc.html#AD	Yes	No	Printable Only
Form	AD-1048	http://rurdev.usda.gov/regs//formstoc.html#AD	Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 47

Affected Public: Private Sector

Private Sector: 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	820	820
Annual IC Time Burden (Hours)	1,050	1,050
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.

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