Information Collection

Private Individuals - Section 9004

IC 189242 under ICR 200912-0570-002 · OMB 0570-0058.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RD 9004-1 Private Individuals - Section 9004	Form
RD 9004-1 Repowering Assistance Program - Application RD 9004-1 Eligibility Application 6-05-09 Final.doc	Form
RD 9004-2 Repowering Assistance Program - Agreement RD 9004-2 Agreement 6-05-09 Final.doc	Form
RD 9004-3 Repowering Assistance Program - Payment Request RD 9004-3 Payment request 6-05-09 Final.doc	Form
RD 400-1 Equal Opportunity Agreement RD 400-1.PDF	Form
RD 400-4 Assurance Agreement RD 400-4.PDF	Form
AD-1047 Certification Regarding Debarment, Suspension, & Other R AD-1047.pdf	Form
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi AD-1048.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	RD 9004-1	Repowering Assistance Program - Application	RD 9004-1 Eligibility Application 6-05-09 Final.doc	Yes	No	Fillable Printable
Form	RD 9004-2	Repowering Assistance Program - Agreement	RD 9004-2 Agreement 6-05-09 Final.doc	Yes	No	Fillable Printable
Form	RD 9004-3	Repowering Assistance Program - Payment Request	RD 9004-3 Payment request 6-05-09 Final.doc	Yes	No	Fillable Printable
Form	RD 400-1	Equal Opportunity Agreement	RD 400-1.PDF	Yes	Yes	Fillable Printable
Form	RD 400-4	Assurance Agreement	RD 400-4.PDF	Yes	Yes	Fillable Printable
Form	AD-1047	Certification Regarding Debarment, Suspension, & Other Responsibility Matters - Primary Covered Transactions	AD-1047.pdf	Yes	No	Fillable Printable
Form	AD-1048	Certification Regarding Debarment, Suspension, Ineligibility & Voluntary Exclusion - Lower tier transactions	AD-1048.pdf	Yes	No	Fillable Printable

Line of Business: Energy

Subfunction: Energy Production

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	22	-6	28
Annual IC Time Burden (Hours)	332	-71	403
Annual IC Cost Burden (Dollars)	0	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.