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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form AD-3031-FS Assurance Regarding Felong Conviction or Tax Delinquent Status for Corporate Applicants (FY 12, 13, & 14)	Form	Modified	Available
Form AD-3030-FS Representations Regarding Felony Conviction & Tax Delinquent Status for Corporate Applicants (FY 12, 13, & 14)	Form	Modified	Available
Form AD-3031-Y Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants (FY 12, 13, & 14)	Form	Modified	Repair queued
Form AD-3030-Y Representations Regarding Felony Conviction & Tax Delinquent Status for Corporate Applicants (FY 2012 and 2013 only)	Form	Modified	Available
Form AD-3031 Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants	Form	Modified	Available
Form AD-3030 Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants	Form	Modified	Available
0505-0025 Justification March 2015.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-03-19	Repair queued
0505-0025 Chg Req Jan 2015.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-01-20	Available
0505-0025 Justification for Change.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-04-03	Available
SuptStmt 12-12-12 renewal final.docx	Supporting Statement A	Uploaded 2012-12-13	Available
2012 renewal Spreadsheet -Final.xlsm	Supplementary Document	Uploaded 2012-12-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202726	Felony or Tax Delinquent Corporations	Form	Modified	Assurance Regarding Felong Conviction or Tax Delinquent Status for Corporate Applicants (FY 12, 13, & 14)
202726	Felony or Tax Delinquent Corporations	Form	Modified	Representations Regarding Felony Conviction & Tax Delinquent Status for Corporate Applicants (FY 12, 13, & 14)
202726	Felony or Tax Delinquent Corporations	Form	Modified	Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants (FY 12, 13, & 14)
202726	Felony or Tax Delinquent Corporations	Form	Modified	Representations Regarding Felony Conviction & Tax Delinquent Status for Corporate Applicants (FY 2012 and 2013 only)
202726	Felony or Tax Delinquent Corporations	Form	Modified	Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants
202726	Felony or Tax Delinquent Corporations	Form	Modified	Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants

ICR Details

OMB Control No: 0505-0025	ICR Reference No: 201503-0505-001
Status: Historical Inactive	Previous ICR Reference No: 201501-0505-001
Agency/Subagency: USDA/OCFO	Agency Tracking No:
Title: Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants & Awardees
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 03/20/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/19/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2016	02/29/2016	02/29/2016
Responses	2,256,097	0	2,256,097
Time Burden (Hours)	564,024	0	564,024
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. 113 - 235 744 and 745 Name of Law: Consolidated and Further Continuation Appropriations Act, 2015

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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

table that charts list of burden

IC Title	Form No.	Form Name
Felony or Tax Delinquent Corporations	AD-3030-Y, AD-3030-FS, AD-3031-FS, AD-3031-Y, 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 ,   Representations Regarding Felony Conviction & Tax Delinquent Status for Corporate Applicants (FY 2012 and 2013 only) ,   Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants (FY 12, 13, & 14) ,   Representations Regarding Felony Conviction & Tax Delinquent Status for Corporate Applicants (FY 12, 13, & 14) ,   Assurance Regarding Felong Conviction or Tax Delinquent Status for Corporate Applicants (FY 12, 13, & 14)

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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:

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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: 03/19/2015

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