SEARCH - American Indian Tribes

Special Evaluation Assistance for Rural Communities and Households Program (SEARCH)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0146 can be found here:

Documents and Forms

Document Name Document Type
Form RD 1940-Q Exhibit SEARCH - American Indian Tribes Form
RD 1940-Q Exhibit CERTIFICATION FOR CONTRACTS, GRANTS AND LOANS RD 1940-Q Exhibit A-1.pdf www.rd.usda.gov/files/PR_1940Q-A1.pdf Form
AD 1047 Certification Regarding Debarment AD-1047 Final (July '15).docx www.ocio.usda.gov/policy-directives-records-forms/forms-management/forms-links Form and Instruction
AD 1048 Certification Regarding Debarment, Suspension, Ineligibi AD-1048 Final (July '15).docx www.ocio.usda.gov/policy-directives-records-forms/forms-management/forms-links Form and Instruction
AD 1049 Certification Regarding Drug-Free Workplace AD-1049 Final (July '15).docx www.ocio.usda.gov/policy-directives-records-forms/forms-management/forms-links Form and Instruction

Information Collection (IC) Details

IC Title:	SEARCH - American Indian Tribes	Agency IC Tracking Number:

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	RD 1940-Q Exhibit A-1	CERTIFICATION FOR CONTRACTS, GRANTS AND LOANS	RD 1940-Q Exhibit A-1.pdf	http://www.rd.usda.gov/files/PR_1940Q-A1.pdf	No		Paper Only
Form and Instruction	AD 1047	Certification Regarding Debarment	AD-1047 Final (July '15).docx	https://www.ocio.usda.gov/policy-directives-records-forms/forms-management/forms-links	Yes	Yes	Fillable Printable
Form and Instruction	AD 1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower tier Transaction	AD-1048 Final (July '15).docx	https://www.ocio.usda.gov/policy-directives-records-forms/forms-management/forms-links	Yes	Yes	Fillable Printable
Form and Instruction	AD 1049	Certification Regarding Drug-Free Workplace	AD-1049 Final (July '15).docx	https://www.ocio.usda.gov/policy-directives-records-forms/forms-management/forms-links	Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16	Number of Respondents for Small Entity: 2

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	176	152	24
Annual IC Time Burden (Hours)	461	398	63
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.