State, Tribal, Local

Rural Business Opportunity Grants - 7 CFR part 4284-G

Documents and Forms

Document Name Document Type
Form AD-1047 State, Tribal, Local Form
AD-1047 Certification Regarding Debarment, Suspension, and Other RD AD1047-F-01-92.docx Form
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi RD AD1048-F-01-92.docx Form
AD-1049 Certification Reguarding Drug-Free Workplace Requirement RD AD1049-F-05-90.docx Form
SF-424 Application for Federal Assistance SF424_2_1-V2.1.pdf Form
RD 400-4 Assurance Agreement RD0400-0004.pdf Form
RD 1940-1 Request for Obligation of Funds RD1940-0001.pdf Form
RD 1942-46 Letter of Intent to Meet Conditions RD1942-0046.pdf Form
RD 4280-2 RBS Grant Agreement RD4280-0002_110800V04.docx Form

Information Collection (IC) Details

IC Title:	State, Tribal, Local	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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AD-1047	Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions	RD AD1047-F-01-92.docx	Yes	No	Fillable Printable
Form	AD-1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions	RD AD1048-F-01-92.docx	Yes	No	Fillable Printable
Form	AD-1049	Certification Reguarding Drug-Free Workplace Requirements	RD AD1049-F-05-90.docx	Yes	No	Fillable Printable
Form	SF-424	Application for Federal Assistance	SF424_2_1-V2.1.pdf	Yes	No	Fillable Printable
Form	RD 400-4	Assurance Agreement	RD0400-0004.pdf	Yes	No	Fillable Printable
Form	RD 1940-1	Request for Obligation of Funds	RD1940-0001.pdf	Yes	No	Fillable Printable
Form	RD 1942-46	Letter of Intent to Meet Conditions	RD1942-0046.pdf	Yes	No	Fillable Printable
Form	RD 4280-2	RBS Grant Agreement	RD4280-0002_110800V04.docx	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: 27	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	214	91	123
Annual IC Time Burden (Hours)	1,797	904	893
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.