Information Collection

Tribal

IC 181552 under ICR 201006-0575-004 · OMB 0575-0180.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0575-0180 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD-1047 Tribal	Form
AD-1047 Certification Regarding Debarrment, etc. AD1047-F-01-92.pdf	Form
AD-1048 Certification Regarding Debarrment, etc. - Lower Tier AD1048-F-01-92.pdf	Form
SF-270 Request for Advance or Reimbursement sf270.pdf	Form
AD-1049 Certification for Drug-Free Workplace AD1049-F-05-90.pdf	Form
SF-LLL Disclosure of Lobbying Activites sflllin.pdf	Form

IC Title:

Tribal

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	AD-1047	Certification Regarding Debarrment, etc.	AD1047-F-01-92.pdf	Yes	No	Fillable Printable
Form	AD-1048	Certification Regarding Debarrment, etc. - Lower Tier	AD1048-F-01-92.pdf	Yes	No	Fillable Printable
Form	SF-270	Request for Advance or Reimbursement	sf270.pdf	Yes	No	Fillable Printable
Form	AD-1049	Certification for Drug-Free Workplace	AD1049-F-05-90.pdf	Yes	No	Fillable Printable
Form	SF-LLL	Disclosure of Lobbying Activites	sflllin.pdf	Yes	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: 126

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	347	221	126
Annual IC Time Burden (Hours)	419	248	171
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.