Private Individuals - Section 9004

Repowering Assistance Payments to Eligible Biorefineries

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Private Individuals - Section 9004	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:

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 %

	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

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.