Agriculture Innovation Centers

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0570-0045 can be found here:

Documents and Forms

Document Name Document Type
Form RD 1940-1 Agriculture Innovation Centers Form
AD 1047 Certification Regarding Debarement, Suspension, and Othe AD-1047.pdf Form and Instruction
AD 1048 Certification Regarding Debarement, Suspension, and Othe AD-1048.pdf Form and Instruction
AD 1049 Certification Regarding Drug-Free Workplace Requirements AD-1049.pdf Form and Instruction
RD 1940-1 Request for Obligation of Funds RD1940-0001.pdf Form
RD 1940-20 Request for Environmental Information RD1940-20.pdf Form
RD 1942-46 Letter of Intent to Meet Conditons RD1942-0046.pdf Form
RD 400-4 Assurance Agreement RD0400-0004.pdf Form
AD 3030 REPRESENTATIONS REGARDING FELONY CONVICTION AND TAX DELI AD_3030-V1.0.pdf Form
AD 3031 ASSURANCE REGARDING FELONY CONVICTION OR TAX DELINQUENT AD_3031-V1.0.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Agriculture Innovation Centers	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-K (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	RD 1940-1	Request for Obligation of Funds	RD1940-0001.pdf	Yes	No	Fillable Printable
Form	RD 1940-20	Request for Environmental Information	RD1940-20.pdf	Yes	No	Fillable Printable
Form	RD 1942-46	Letter of Intent to Meet Conditons	RD1942-0046.pdf	Yes	No	Fillable Printable
Form	RD 400-4	Assurance Agreement	RD0400-0004.pdf	Yes	No	Fillable Printable
Form	AD 3030	REPRESENTATIONS REGARDING FELONY CONVICTION AND TAX DELINQUENT STATUS FOR CORPORATE APPLICANTS	AD_3030-V1.0.pdf	Yes	No	Fillable Printable
Form	AD 3031	ASSURANCE REGARDING FELONY CONVICTION OR TAX DELINQUENT STATUS FOR CORPORATE APPLICANTS	AD_3031-V1.0.pdf	Yes	No	Fillable Printable
Form and Instruction	AD 1047	Certification Regarding Debarement, Suspension, and Other Responsibility Matters	AD-1047.pdf	Yes	No	Fillable Fileable
Form and Instruction	AD 1048	Certification Regarding Debarement, Suspension, and Other Responsibility Matters - Lower Tier	AD-1048.pdf	Yes	No	Fillable Printable
Form and Instruction	AD 1049	Certification Regarding Drug-Free Workplace Requirements	AD-1049.pdf	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: 1	Number of Respondents for Small Entity: 1

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 60 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15	-35	50
Annual IC Time Burden (Hours)	30	-62	92
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.