Information Collection

USDA Rural Child Poverty Nutrition Center

IC 212622 under ICR 201209-0584-003 · OMB 0584-0512.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0512 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
RFA Rural Child Poverty Nutrition Center - GMD_8-1-14.doc www.grants.gov	Other-Request for Applications
Request to OMB to Use 0584-0512 (CN Rural Communities Grant) 8-11-14.docx OMB Generic Clearance Justification Memo	IC Document
CN Rural Communities Grant Program_Supporting Statement 8-11-2014 prao-2nd round.docx Supporting Statement	IC Document
SF-425 screenshot.docx SF-425 screenshot	IC Document
sflll.pdf Disclosure of Lobby Activities	IC Document
RR_FedNonFedBudget-V1.1.pdf R&R Federal Non Federal Budget	IC Document
RR_SubawardBudget_1_3-V1.3.pdf R&R Sub Award Budget	IC Document
RRSF424_SF424B-V1.1.pdf R&R SF 424 B	IC Document
AD1047-F-01-92.pdf Certification Regarding Debarment, Suspension or Ohter Responsibility Matters	IC Document
AD1048-F-01-92.pdf Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions	IC Document
AD1049-F-05-90.pdf CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS) ALTERNATIVE I - FOR GRANTEES OTHER THAN INDIVIDUALS	IC Document
Terms and Conditions - FINAL for CN Rural RFA ICR 2014.docx Terms and Conditions	IC Document

IC Title:

USDA Rural Child Poverty Nutrition Center

Agency IC Tracking Number:

Rural Communities

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Request for Applications			RFA Rural Child Poverty Nutrition Center - GMD_8-1-14.doc	www.grants.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	38	38
Annual IC Time Burden (Hours)	721	721
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Generic Clearance Justification Memo	Request to OMB to Use 0584-0512 (CN Rural Communities Grant) 8-11-14.docx	08/11/2014
Supporting Statement	CN Rural Communities Grant Program_Supporting Statement 8-11-2014 prao-2nd round.docx	08/11/2014
SF-425 screenshot	SF-425 screenshot.docx	08/11/2014
Disclosure of Lobby Activities	sflll.pdf	08/11/2014
R&R Federal Non Federal Budget	RR_FedNonFedBudget-V1.1.pdf	08/11/2014
R&R Sub Award Budget	RR_SubawardBudget_1_3-V1.3.pdf	08/11/2014
R&R SF 424 B	RRSF424_SF424B-V1.1.pdf	08/11/2014
Certification Regarding Debarment, Suspension or Ohter Responsibility Matters	AD1047-F-01-92.pdf	08/11/2014
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions	AD1048-F-01-92.pdf	08/11/2014
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS) ALTERNATIVE I - FOR GRANTEES OTHER THAN INDIVIDUALS	AD1049-F-05-90.pdf	08/11/2014
Terms and Conditions	Terms and Conditions - FINAL for CN Rural RFA ICR 2014.docx	08/11/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.