USDA Rural Child Poverty Nutrition Center

Uniform Grant Application for Non-Entitlement Discretionary Grants

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.