Information Collection

Community Outreach and Assistance Partnership Program

IC 1628 under ICR 201005-0563-003 · OMB 0563-0066.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0563-0066 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD 1047 Community Outreach and Assistance Partnership Program	Form and Instruction
AD 1047 Certification Regarding Debarment, Suspension, & other R AD 1047.pdf	Form and Instruction
AD 1049 Certification Regarding Drug-Free Workplace Requirements AD 1049.pdf	Form and Instruction
SF-LLL Disclosure of Lobbying Activities SF-LLL.pdf	Form and Instruction

IC Title:

Community Outreach and Assistance Partnership 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:

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 and Instruction	AD 1047	Certification Regarding Debarment, Suspension, & other Responsibility Matters - Primary Covered Transactions	AD 1047.pdf	Yes	No	Printable Only
Form and Instruction	AD 1049	Certification Regarding Drug-Free Workplace Requirements (Grants)	AD 1049.pdf	Yes	No	Printable Only
Form and Instruction	SF-LLL	Disclosure of Lobbying Activities	SF-LLL.pdf	Yes	No	Printable Only

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	960	860	100
Annual IC Time Burden (Hours)	1,216	249	967
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.