Information Collection

Technical Assistance Program - American Indian Tribes

IC 193387 under ICR 201705-0572-001 · OMB 0572-0112.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0112 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD-1047 Technical Assistance Program - American Indian Tribes	Form and Instruction
AD-1047 Certification Regarding Debarment, Suspension, and Other AD_1047-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Form and Instruction
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi AD_1048-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Form and Instruction
AD - 1049 Certification Regarding Drug-Free Workplace Requirements AD_1049-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Form and Instruction
SF-424 Application for Federal Assistance SF424_2_1-V2.1.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Form and Instruction
SF 424B Assurances - Non-Construction Programs SF424B-V1.1.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Form and Instruction
Ad-3030 REPRESENTATIONS REGARDING FELONY CONVICTION AD_3030_1_1-V1.1.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Form and Instruction
AD-3031 ASSURANCE REGARDING FELONY CONVICTION AD_3031_1_1-V1.1.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Form and Instruction
SF-LLL DISCLOSURE OF LOBBYING ACTIVITIES SFLLL_1_2_P-V1.2.pdf www.grants.gov/web/grants/forms/post-award-reporting-forms.html#sortby=1	Form and Instruction
SF-425 Federal Financial Report SF425-V1.0.pdf www.grants.gov/web/grants/forms/post-award-reporting-forms.html#sortby=1	Form and Instruction
SF 270 Request for Advance or Reimbursement SF270-V1.0.pdf www.grants.gov/web/grants/forms/post-award-reporting-forms.html#sortby=1	Form and Instruction
SF-424A Budget Information - Non-Construction Programs SF424A-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Technical Assistance Program - 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: 7 CFR 1775

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	AD-1047	Certification Regarding Debarment, Suspension, and Other Responsibility Matters	AD_1047-V1.0.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	AD-1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	AD_1048-V1.0.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	AD - 1049	Certification Regarding Drug-Free Workplace Requirements (Grants)	AD_1049-V1.0.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SF-424	Application for Federal Assistance	SF424_2_1-V2.1.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SF 424B	Assurances - Non-Construction Programs	SF424B-V1.1.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	Ad-3030	REPRESENTATIONS REGARDING FELONY CONVICTION	AD_3030_1_1-V1.1.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	AD-3031	ASSURANCE REGARDING FELONY CONVICTION	AD_3031_1_1-V1.1.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SF-LLL	DISCLOSURE OF LOBBYING ACTIVITIES	SFLLL_1_2_P-V1.2.pdf	https://www.grants.gov/web/grants/forms/post-award-reporting-forms.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SF-425	Federal Financial Report	SF425-V1.0.pdf	https://www.grants.gov/web/grants/forms/post-award-reporting-forms.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SF 270	Request for Advance or Reimbursement	SF270-V1.0.pdf	https://www.grants.gov/web/grants/forms/post-award-reporting-forms.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SF-424A	Budget Information - Non-Construction Programs	SF424A-V1.0.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	303	24	279
Annual IC Time Burden (Hours)	1,274	293	981
Annual IC Cost Burden (Dollars)	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.