Rural Community Development Initiative (RCDI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form AD 3030 Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants	Form	Modified	Available
Form RD 442-3 Balance Sheet	Form	Modified	Available
Form RD 442-2 Statement of Budget, Income and Equity	Form	Modified	Available
Form RD 400-4 Assurance Agreement	Form	Modified	Available
Form RD 400-1 Equal Opportunity Agreement	Form	Modified	Available
Form AD-1048 Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees other than Individuals	Form	Modified	Available
Form AD-1047 Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions	Form	Modified	Available
Form AD-1049 Certification Regarding Drug-free Workplace	Form	Modified	Available
Form AD 3030 Representations Regarding Felony Conviction and Tax Delinquent Status for Coporate Applicants	Form	Modified	Available
Form RD 442-3 Balance Sheet	Form	Modified	Available
Form RD 442-2 Statement of Budget, Income and Equity	Form	Modified	Available
Form RD 400-4 Assurance Agreement	Form	Modified	Available
Form RD 400-1 Equal Opportunity Agreement	Form	Modified	Available
Form AD-1049 Certification for Drug-Free Workplace	Form	Modified	Available
Form AD-1048 Certification Regarding Debarrment, etc. - Lower Tier	Form	Modified	Available
Form AD-1047 Certification Regarding Debarrment, etc.	Form	Modified	Available
SF424_2_1-V2.1.pdf	Supplementary Document	Uploaded 2018-04-10	Available
SFLLL_1_2-V1.2.pdf	Supplementary Document	Uploaded 2018-04-10	Available
SF270-V1.0.pdf	Supplementary Document	Uploaded 2018-04-10	Available
Summary of Information Collection - RCDI Spreadsheet 2-2018.xlsm	Supplementary Document	Uploaded 2018-04-10	Available
RCDI Supporting Statement.docx	Supporting Statement A	Uploaded 2018-04-10	Available
SF424B-V1.1.pdf	Supplementary Document	Uploaded 2018-04-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
2036	Private	Form	Modified	Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants
2036	Private	Form	Modified	Balance Sheet
2036	Private	Form	Modified	Statement of Budget, Income and Equity
2036	Private	Form	Modified	Assurance Agreement
2036	Private	Form	Modified	Equal Opportunity Agreement
2036	Private	Form	Modified	Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees other than Individuals
2036	Private	Form	Modified	Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions
2036	Private	Form	Modified	Certification Regarding Drug-free Workplace
181552	Public/Tribal	Form	Modified	Representations Regarding Felony Conviction and Tax Delinquent Status for Coporate Applicants
181552	Public/Tribal	Form	Modified	Balance Sheet
181552	Public/Tribal	Form	Modified	Statement of Budget, Income and Equity
181552	Public/Tribal	Form	Modified	Assurance Agreement
181552	Public/Tribal	Form	Modified	Equal Opportunity Agreement
181552	Public/Tribal	Form	Modified	Certification for Drug-Free Workplace
181552	Public/Tribal	Form	Modified	Certification Regarding Debarrment, etc. - Lower Tier
181552	Public/Tribal	Form	Modified	Certification Regarding Debarrment, etc.

ICR Details

OMB Control No: 0575-0180	ICR Reference No: 201804-0575-001
Status: Historical Active	Previous ICR Reference No: 201401-0575-003
Agency/Subagency: USDA/RHS	Agency Tracking No:
Title: Rural Community Development Initiative (RCDI)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/23/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/21/2018
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2021	36 Months From Approved	07/31/2018
Responses	3,640	0	4,400
Time Burden (Hours)	4,549	0	5,556
Cost Burden (Dollars)	0	0	0

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Abstract: The Rural Community Development Initiative's intent is to develop the capacity and ability of rural area recipients through a program of technical assistance provided by qualified intermediary organizations.

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Authorizing Statute(s): PL: Pub.L. 106 - 78 306 Name of Law: Agriculture, Rural Development, FDA 7 Related Agencies Appropriations Act 2000
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 4895	02/02/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 23414	05/21/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Private	RD 400-1, RD 400-4, RD 442-2, RD 442-3, AD-1048, AD-1047, AD-1049, AD 3030	Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions ,   Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees other than Individuals ,   Certification Regarding Drug-free Workplace ,   Equal Opportunity Agreement ,   Assurance Agreement ,   Statement of Budget, Income and Equity ,   Balance Sheet ,   Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants
Public/Tribal	RD 400-1, RD 400-4, RD 442-2, RD 442-3, AD-1048 , AD-1047, AD-1049, AD 3030	Certification Regarding Debarrment, etc. ,   Certification Regarding Debarrment, etc. - Lower Tier ,   Certification for Drug-Free Workplace ,   Equal Opportunity Agreement ,   Assurance Agreement ,   Statement of Budget, Income and Equity ,   Balance Sheet ,   Representations Regarding Felony Conviction and Tax Delinquent Status for Coporate Applicants

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,640	4,400	0	0	-760	0
Annual Time Burden (Hours)	4,549	5,556	0	0	-1,007	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: With this renewal, annual responses decreased by 760 to 3,640 and hours decreased by 1,007 for a total of 4,549 in burden. The adjustment decrease in both the number of responses and hours is based on a decrease in the number of respondents.

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Annual Cost to Federal Government: $289,889

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/21/2018

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