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

Grant Program to Establish a Revolving Fund Program (RFP) to Finance Water and Wastewater Projects, 7 CFR 1783

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0138 can be found here:

Documents and Forms

Document Name Document Type
Form AD 1048 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

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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AD 1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	UEP_AD 1048.pdf	http://www.rd.usda.gov/files/UEP_sample_DebarLT.pdf	Yes	No	Fillable Printable
Form and Instruction	RD 400-4	Assurance Agreement	ND_FormRD400-4_AssuranceAgreement.pdf	http://www.rd.usda.gov/files/ND_FormRD400-4_AssuranceAgreement.pdf	Yes	No	Fillable Printable
Form and Instruction	RD 400-1	Equal Opportunity Agreement	vtnh.RBDG_.RD 400-1.16.pdf	http://www.rd.usda.gov/files/vtnh.RBDG_.RD%20400-1.16.pdf	Yes	No	Fillable Printable
Form and Instruction	AD-1047	Certification Regarding Debarment, Suspension, & other Responsibility Matters - Primary Covered Transactions	AD-1047 (Dec '15).pdf	http://www.rd.usda.gov/files/UEP_sample_DebraLT.pdf	Yes	No	Fillable Printable
Form and Instruction	AD-1049	Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - For Grantees other than Individuals	AD-1049 (Dec '15) (1).pdf	http://www.rd.usda.gov/files/UEP_sample_DebraLT.pdf	Yes	No	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: 4	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	66	6	60
Annual IC Time Burden (Hours)	376	2	374
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.