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non-profit / private sector
The Rural Alaska Village Grant (RAVG) Program
OMB: 0572-0150
IC ID: 209670
OMB.report
USDA/RUS
OMB 0572-0150
ICR 201507-0572-001
IC 209670
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0150 can be found here:
2022-02-22 - Revision of a currently approved collection
2018-11-26 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form AD -1047
non-profit / private sector
Form
AD -1047 Certification Regarding Debarment
AD1047-F-01-92.docx
www.rurdev.usda.gov/FormsAndPublications.html
Form
AD- 1048 Certification Regarding Debarment, Suspension, Ineligibi
AD1048-F-01-92.docx
www.rurdev.usda.gov/FormsAndPublications.html
Form
AD - 1049 Certification Regarding Drug-Free Workplace
AD1049-F-05-90.docx
www.rurdev.usda.gov/FormsAndPublications.html
Form
RD Instruction 194 Certification for Contracts, Grants and Loans REgarding
RD Instruction 1940Q A-1.pdf
www.rurdev.usda.gov/FormsAndPublications.html
Form and Instruction
RD 400-1 Equal Opportunity Agreement
RD400-1.pdf
www.rurdev.usda.gov/FormsAndPublications.html
Form
RD 400-4 Assurance Agreement
RD400-4.pdf
www.rurdev.usda.gov/FormsAndPublications.html
Form
RD 442-22 Opinion of COunsel relative to RIght-of-Way & Easments
RD442-22.pdf
www.rurdev.usda.gov/FormsAndPublications.html
Form
RD 1942-46 Letter of Intent to Meet Conditions
RD1942-46.pdf
www.rurdev.usda.gov/FormsAndPublications.html
Form
SF 424 Application for Federal Assistance
SF424.pdf
www.grants.gov
Form and Instruction
RUS Bulletin 1780- RUS Bulletin 1780-12
RUS_Bulletin_1780-12.pdf
www.rurdev.usda.gov/FormsAndPublications.html
Form and Instruction
RAVG SOA Grant Agreement
RAVG SOA Grant Agreement FINAL.docx
www.rurdev.usda.gov/FormsAndPublications.html
Form
RAVG ANTHC Grant Agreement
RAVG ANTHC Grant Agreement FINAL.doc
www.rurdev.usda.gov/FormsAndPublications.html
Form
SF424C_.pdf
SF 424C - Budget Information - Construciton Programs
IC Document
SF424D.pdf
SF 424D - Assurances - Construction Programs
IC Document
SFLLL.pdf
SF LLL - Disclosure of Lobbying Activities
IC Document
SF424A-V1.0.pdf
SF-424A, “Budget Information--Non-Construction Programs
IC Document
SF424B-V1.1.pdf
SF-424B, “Assurances--Non-construction Programs
IC Document
RUS266.pdf
RUS Form 266 “Compliance Assurance
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
non-profit / private sector
Agency IC Tracking Number:
0572
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
AD -1047
Certification Regarding Debarment
AD1047-F-01-92.docx
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
AD- 1048
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Transaction
AD1048-F-01-92.docx
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
AD - 1049
Certification Regarding Drug-Free Workplace
AD1049-F-05-90.docx
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form and Instruction
RD Instruction 1940Q A-1
Certification for Contracts, Grants and Loans REgarding Lobbying
RD Instruction 1940Q A-1.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 400-1
Equal Opportunity Agreement
RD400-1.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 400-4
Assurance Agreement
RD400-4.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 442-22
Opinion of COunsel relative to RIght-of-Way & Easments
RD442-22.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
RD 1942-46
Letter of Intent to Meet Conditions
RD1942-46.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form and Instruction
SF 424
Application for Federal Assistance
SF424.pdf
http://www.grants.gov
Yes
No
Fillable Printable
Form and Instruction
RUS Bulletin 1780-12
RUS Bulletin 1780-12
RUS_Bulletin_1780-12.pdf
http://www.rurdev.usda.gov/FormsAndPublications.html
Yes
No
Fillable Printable
Form
None
RAVG SOA Grant Agreement
RAVG SOA Grant Agreement FINAL.docx
http://www.rurdev.usda.gov/FormsAndPublications.html
No
Fillable Printable
Form
None
RAVG ANTHC Grant Agreement
RAVG ANTHC Grant Agreement FINAL.doc
http://www.rurdev.usda.gov/FormsAndPublications.html
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Community and Regional Development
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
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
138
0
138
0
0
0
Annual IC Time Burden (Hours)
188
0
188
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SF 424C - Budget Information - Construciton Programs
SF424C_.pdf
12/12/2013
SF 424D - Assurances - Construction Programs
SF424D.pdf
12/12/2013
SF LLL - Disclosure of Lobbying Activities
SFLLL.pdf
12/12/2013
SF-424A, “Budget Information--Non-Construction Programs
SF424A-V1.0.pdf
07/29/2015
SF-424B, “Assurances--Non-construction Programs
SF424B-V1.1.pdf
07/29/2015
RUS Form 266 “Compliance Assurance
RUS266.pdf
07/29/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.