Information Collection

Agriculture Innovation Centers

IC 1741 under ICR 201204-0570-001 · OMB 0570-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0570-0045 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD 1047 Agriculture Innovation Centers	Form and Instruction
AD 1047 Certification Regarding Debarement, Suspension, and Othe AD1047-F-01-92.pdf	Form and Instruction
AD 1048 Certification Regarding Debarement, Suspension, and Othe AD1048-F-01-92.pdf	Form and Instruction
AD 1049 Certification Regarding Drug-Free Workplace Requirements AD1049-F-05-90.pdf	Form and Instruction
RD Instruction 194 Certification for Contracts, Grants and Loans 1940q a1.pdf	Form
SF-425 Federal Financial Report SF-425.pdf	Form
SF 270 Request for Advance or Reimbursement sf270.pdf	Form

IC Title:

Agriculture Innovation Centers

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 4284-K (To search for a specific CFR, visit the Code of Federal Regulations.)

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 Debarement, Suspension, and Other Responsibility Matters	AD1047-F-01-92.pdf	Yes	No	Fillable Fileable
Form and Instruction	AD 1048	Certification Regarding Debarement, Suspension, and Other Responsibility Matters - Lower Tier	AD1048-F-01-92.pdf	Yes	No	Fillable Printable
Form and Instruction	AD 1049	Certification Regarding Drug-Free Workplace Requirements	AD1049-F-05-90.pdf	Yes	No	Fillable Printable
Form	RD Instruction 1940-Q, Exhibit A-1	Certification for Contracts, Grants and Loans	1940q a1.pdf	Yes	No	Fillable Printable
Form	SF-425	Federal Financial Report	SF-425.pdf	Yes	No	Fillable Printable
Form	SF 270	Request for Advance or Reimbursement	sf270.pdf	Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2

Number of Respondents for Small Entity: 2

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 60 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	-30	80
Annual IC Time Burden (Hours)	92	-48	140
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.