Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants & Awardees

Forms and Documents

Document Name	Status
Form AD-3030-FS Felony or Tax Delinquent Corporations Form	Modified
SuptStmt 12-12-12 renewal final.docx Supporting Statement A	2012-12-13
2012 renewal Spreadsheet -Final.xlsm Supplementary Document	2012-12-13

IC Document Collections

IC ID	Document Title	Status
202726	Felony or Tax Delinquent Corporations Form	Modified

ICR Details

OMB Control No: 0505-0025	ICR Reference No: 201212-0505-001
Status: Historical Active	Previous ICR Reference No: 201211-0505-001
Agency/Subagency: USDA/OCFO	Agency Tracking No:
Title: Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants & Awardees
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/13/2013
	Date Received in OIRA: 12/13/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2016	36 Months From Approved	02/28/2013
Responses	2,256,097	0	2,162,535
Time Burden (Hours)	564,024	0	540,634
Cost Burden (Dollars)	0	0	0

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Abstract: Information collected will be used to evaluate corporate applicants and awardees felony conviction and tax delinquency status prior to entering into new non-procurement contracts, grants, loans, loan guarantees, cooperative agreements and some memoranda of agreement. The information is needed to ensure fiscal year funds are not inappropriately disbursed.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: PL: Pub.L. 112 - 55 738 and 739 Name of Law: Agriculture, rural Development Food and Drug Administration, and Related Agencies Approp Act, 2012
PL: Pub.L. 112 - 74 433 and 434 Name of Law: Consolidated Appropriations Act, 2012

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 62213	10/12/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 74164	12/13/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Felony or Tax Delinquent Corporations	AD-3030-FS, AD-3031-FS, AD-3030, AD-3031	Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants ,   Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants ,   Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants ,   Representation Regarding Felony Convition and Tax Delinquent Status for Corporate Applicants

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,256,097	2,162,535	0	0	93,562	0
Annual Time Burden (Hours)	564,024	540,634	0	0	23,390	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is a bookkeeping correction to show a more accurate number of respondents. This resulted in a decrease of respondents but an increase in responses per respondent. There is a decrease of 1,420,991 respondents but an adjustment increase (93,562)in responses and an adjustment increase (23,390) in burden hours as a resulting of this correction.

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Annual Cost to Federal Government: $49,478,800

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/13/2012

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