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Federal forms, ICRs, and supporting documents

Information Collection

7 CFR 1783, Grant Program to Estb. a Revolving Fund Program (RFP) to finance Water and Wastewater Proj.

IC 1887 under ICR 201608-0572-003 · OMB 0572-0138.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form RD 400-1
Equal Opportunity Agreement 7 CFR 1783, Grant Program to Estb. a Revolving Fund Program (RFP) to finance Water and Wastewater Proj.		 Form and Instruction
Form AD 1048
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion 7 CFR 1783, Grant Program to Estb. a Revolving Fund Program (RFP) to finance Water and Wastewater Proj.		 Form and Instruction
Form RD 400-4
Assurance Agreement 7 CFR 1783, Grant Program to Estb. a Revolving Fund Program (RFP) to finance Water and Wastewater Proj.		 Form and Instruction
Form AD-1047
Certification Regarding Debarment, Suspension, & other Responsibility Matters - Primary Covered Transactions 7 CFR 1783, Grant Program to Estb. a Revolving Fund Program (RFP) to finance Water and Wastewater Proj.		 Form and Instruction
Form AD-1049
Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - For Grantees other than Individuals 7 CFR 1783, Grant Program to Estb. a Revolving Fund Program (RFP) to finance Water and Wastewater Proj.		 Form and Instruction
RD 400-1 Equal Opportunity Agreement
vtnh.RBDG_.RD 400-1.16.pdf
www.rd.usda.gov/files/vtnh.RBDG_.RD%20400-1.16.pdf 		Form and Instruction
AD 1048 Certification Regarding Debarment, Suspension, Ineligibi
UEP_AD 1048.pdf
www.rd.usda.gov/files/UEP_sample_DebarLT.pdf 		Form and Instruction
RD 400-4 Assurance Agreement
ND_FormRD400-4_AssuranceAgreement.pdf
www.rd.usda.gov/files/ND_FormRD400-4_AssuranceAgreement.pdf 		Form and Instruction
AD-1047 Certification Regarding Debarment, Suspension, & other R
AD-1047 (Dec '15).pdf
www.rd.usda.gov/files/UEP_sample_DebraLT.pdf 		Form and Instruction
AD-1049 Certification Regarding Drug-Free Workplace Requirements
AD-1049 (Dec '15) (1).pdf
www.rd.usda.gov/files/UEP_sample_DebraLT.pdf 		Form and Instruction

Information Collection (IC) Details

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Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction RD 400-1 http://www.rd.usda.gov/files/vtnh.RBDG_.RD%20400-1.16.pdf Yes No Fillable Printable
Form and Instruction AD 1048 http://www.rd.usda.gov/files/UEP_sample_DebarLT.pdf Yes No Fillable Printable
Form and Instruction RD 400-4 http://www.rd.usda.gov/files/ND_FormRD400-4_AssuranceAgreement.pdf Yes No Fillable Printable
Form and Instruction AD-1047 http://www.rd.usda.gov/files/UEP_sample_DebraLT.pdf Yes No Fillable Printable
Form and Instruction AD-1049 http://www.rd.usda.gov/files/UEP_sample_DebraLT.pdf Yes No Fillable Printable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 66 0 0 6 0 60
Annual IC Time Burden (Hours) 376 0 0 2 0 374
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
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.
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