Information Collection

Intermediairy Relending Program

IC 1690 under ICR 200904-0570-002 · OMB 0570-0021.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0570-0021 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RD 4274-5 Intermediairy Relending Program	Form
RD 4274-5 Intermediary Relending Program Supplemental Loan Agreeme 4274-05.pdf	Form
RD 4274-1 Application for Loan 4274-01.pdf	Form
RD 4274-3 Intermediary Relending Program Promissory Note 4274-03.pdf	Form
RD 4273-4 Intermediary Relending Program Loan Agreement 4274-04.pdf	Form
RD 400-4.pdf Assurance Agreement (Approved under 0575-0018)	IC Document
RD 400-8.pdf Compliance Review (Approved under 0575-0018)	IC Document
RD402-1.pdf Deposit Agreement (Approved under 0575-0158)	IC Document
RD1951-4.pdf Report of IRP/RDLF Lending Activity (Approved under 0570-0015)	IC Document
RD1940-20.pdf Request for Environmental Information (Approved under 0575-0094)	IC Document

IC Title:

Intermediairy Relending Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 4274

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	RD 4274-5	Intermediary Relending Program Supplemental Loan Agreement	4274-05.pdf	Yes	No	Fillable Printable
Form	RD 4274-1	Application for Loan	4274-01.pdf	Yes	No	Fillable Printable
Form	RD 4274-3	Intermediary Relending Program Promissory Note	4274-03.pdf	Yes	No	Fillable Printable
Form	RD 4273-4	Intermediary Relending Program Loan Agreement	4274-04.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: 202

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,383	-20	2,403
Annual IC Time Burden (Hours)	17,959	0	17,959
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Assurance Agreement (Approved under 0575-0018)	RD 400-4.pdf	12/09/2009
Compliance Review (Approved under 0575-0018)	RD 400-8.pdf	12/09/2009
Deposit Agreement (Approved under 0575-0158)	RD402-1.pdf	12/09/2009
Report of IRP/RDLF Lending Activity (Approved under 0570-0015)	RD1951-4.pdf	12/09/2009
Request for Environmental Information (Approved under 0575-0094)	RD1940-20.pdf	12/09/2009

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