Information Collection

Water and Waste Loan and Grant Program - State, Local, Tribal Government

IC 43532 under ICR 201106-0572-002 · OMB 0572-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0121 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD 1047 Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form
AD 1047 Certification Regarding Debarment, Suspension, and Other ad1047.pdf www.rurdev.usda.gov/ca/pdf%20files%20and%20documents/cf%20ad%20form%201047.pdf	Form
AD 1049 Drug Free Work Place ad-1049.pdf www.rurdev.usda.gov/rbs/coops/ad1049.pdf	Form
Bulletin 1780-12 Grant Agreement Bulletin 1780-12..pdf www.rurdev.usda.gov/SupportDocuments/UWP-rb-12.pdf	Form and Instruction
Bulleting 1780-28 Loan Resolution, Security Agreement bulletin 1780-28.doc www.googlesyndicatedsearch.com/u/RD?q=Bulleitin%201780-28	Form and Instruction
Bulletin 1780-27 Loan Resolution (Public Bodies) bulletin 1780-27.doc www.rurdev.usda.gov/RDU_Bulletins_Water_and_Environmental.html	Form and Instruction

IC Title:

Water and Waste Loan and Grant Program - State, Local, Tribal Government

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 1780

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form	AD 1047	Certification Regarding Debarment, Suspension, and Other	ad1047.pdf	http://www.rurdev.usda.gov/ca/pdf%20files%20and%20documents/cf%20ad%20form%201047.pdf	No	Fillable Printable
Form	AD 1049	Drug Free Work Place	ad-1049.pdf	http://www.rurdev.usda.gov/rbs/coops/ad1049.pdf	No	Fillable Printable
Form and Instruction	Bulletin 1780-12	Grant Agreement	Bulletin 1780-12..pdf	http://www.rurdev.usda.gov/SupportDocuments/UWP-rb-12.pdf	No	Fillable Printable
Form and Instruction	Bulleting 1780-28	Loan Resolution, Security Agreement	bulletin 1780-28.doc	http://www.googlesyndicatedsearch.com/u/RD?q=Bulleitin%201780-28	No	Fillable Printable
Form and Instruction	Bulletin 1780-27	Loan Resolution (Public Bodies)	bulletin 1780-27.doc	http://www.rurdev.usda.gov/RDU_Bulletins_Water_and_Environmental.html	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 733

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	43,583	-3,021	46,604
Annual IC Time Burden (Hours)	91,006	-51,760	142,766
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.