Information Collection

SEARCH - Private Sector

IC 191564 under ICR 201005-0572-003 · OMB 0572-0146.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0146 can be found here:

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 and Instruction
Form AD 1048 Certification regarding Debarment SEARCH - Private Sector	Form and Instruction
Form SF 270 Req. for Adv. or Reimbursement SEARCH - Private Sector	Form and Instruction
Form SF 269a -Short for Financial Status Report SEARCH - Private Sector	Form and Instruction
AD 1047 Certification Regarding Debarment ad1047.pdf www.usda.gov/rus/water/wwforms.htm	Form
AD 1049 Certification for a Drug Free Workplace ad1049.pdf www.usda.gov/rus/water/wwforms.htm	Form and Instruction
AD 1048 Certification regarding Debarment AD1048.pdf www.usda.gov/rus/water/wwforms.htm	Form and Instruction
SF 270 Req. for Adv. or Reimbursement sf270.pdf	Form and Instruction
SF 269a -Short for Financial Status Report sf269a.pdf	Form and Instruction

IC Title:

SEARCH - Private Sector

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.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AD 1047	http://www.usda.gov/rus/water/wwforms.htm	Yes	No	Fillable Printable
Form and Instruction	AD 1049	http://www.usda.gov/rus/water/wwforms.htm	Yes	No	Fillable Printable
Form and Instruction	AD 1048	http://www.usda.gov/rus/water/wwforms.htm	Yes	No	Fillable Printable
Form and Instruction	SF 270	www.whitehouse.gov/omb/grants/sf270.pdf	No		Fillable Printable
Form and Instruction	SF 269a -Short form	www.whitehouse.gov/omb/grants/sf269a.pdf	No		Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 47

Number of Respondents for Small Entity: 43

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	508	508
Annual IC Time Burden (Hours)	1,082	1,082
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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