Information Collection

A4- Direct Certification RFA (SLT)

IC 235881 under ICR 201807-0584-003 · OMB 0584-0512.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0512 can be found here:

Documents and Forms

Document Name Document Type
Form AD-1047 A4- Direct Certification RFA (SLT) Form
Attachment A4 CN Direct Certification Template 7-10-19.docx www.grants.gov Other-Request for Application Templa
AD-1047 DebarmentCert-PrimaryCovered AD-1047 DebarmentCert-PrimaryCovered 4-2022.pdf www.grants.gov Form
AD-1048 DebarmentCert-LowerTierCovered AD-1048 DebarmentCert-LowerTierCovered 4-2022.pdf www.grants.gov Form
AD-1049 DrugFreeCert-Alt1 4-2022.pdf AD-1049 DrugFreeCert-Alt1 4-2022.pdf www.grants.gov Form
AD-1050 DrugFreeCert-Alt2 - 4-2022.pdf AD-1050 DrugFreeCert-Alt2 - 4-2022.pdf www.grants.gov Form
AD-1052 DrugFreeCert-FedFY 4-2022.pdf AD-1052 DrugFreeCert-FedFY 4-2022.pdf www.grants.gov Form
SF 425 Screenshots FederalFinancialReport SF-425 Screenshots.pdf www.fprs.gov Form
SF 425 FederalFinancialReport SF425_2_0-V2.0 exp 2-2022.pdf www.grants.gov Form
FNS 906 GRANT PROGRAM ACCOUNTING SYSTEM & FINANCIAL CAPABILITY Q FNS-906.pdf www.grants.gov Form
FNS 908 PERFORMANCE PROGRESS REPORT FNS-908 April 2019.pdf www.grants.gov Form
Award Terms and Conditions - Generic - 2.21.2019.docx Award Terms and Conditions - Generic - 2.21.2019.docx IC Document
AD_3030_2_0-V2.0.pdf AD 3030 IC Document
SF424_2_1-V2.1.pdf SF 424 IC Document
SF424A-V1.0.pdf SF 424A IC Document
SF424B-V1.1.pdf SF 424B IC Document
SF424C_2_0-V2.0.pdf SF 424C IC Document
SF424D-V1.1.pdf SF 424D IC Document
SFLLL_1_2-V1.2.pdf SF LLL IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	A4- Direct Certification RFA (SLT)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AD-1047	DebarmentCert-PrimaryCovered	AD-1047 DebarmentCert-PrimaryCovered 4-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	AD-1048	DebarmentCert-LowerTierCovered	AD-1048 DebarmentCert-LowerTierCovered 4-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	AD-1049	DrugFreeCert-Alt1 4-2022.pdf	AD-1049 DrugFreeCert-Alt1 4-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	AD-1050	DrugFreeCert-Alt2 - 4-2022.pdf	AD-1050 DrugFreeCert-Alt2 - 4-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	AD-1052	DrugFreeCert-FedFY 4-2022.pdf	AD-1052 DrugFreeCert-FedFY 4-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	SF 425 Screenshots	FederalFinancialReport	SF-425 Screenshots.pdf	www.fprs.gov	Yes	Yes	Fillable Fileable Signable
Form	SF 425	FederalFinancialReport	SF425_2_0-V2.0 exp 2-2022.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	FNS 906	GRANT PROGRAM ACCOUNTING SYSTEM & FINANCIAL CAPABILITY QUESTIONNAIRE	FNS-906.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Form	FNS 908	PERFORMANCE PROGRESS REPORT	FNS-908 April 2019.pdf	www.grants.gov	Yes	Yes	Fillable Fileable Signable
Other-Request for Application Template			Attachment A4 CN Direct Certification Template 7-10-19.docx	www.grants.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: USDA e-Authentication Service	FR Citation: 77 FR 15024

Number of Respondents: 48	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,296	1,296
Annual IC Time Burden (Hours)	3,275	3,275
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Award Terms and Conditions - Generic - 2.21.2019.docx	Award Terms and Conditions - Generic - 2.21.2019.docx	05/07/2019
AD 3030	AD_3030_2_0-V2.0.pdf	05/30/2019
SF 424	SF424_2_1-V2.1.pdf	05/30/2019
SF 424A	SF424A-V1.0.pdf	05/30/2019
SF 424B	SF424B-V1.1.pdf	05/30/2019
SF 424C	SF424C_2_0-V2.0.pdf	05/30/2019
SF 424D	SF424D-V1.1.pdf	05/30/2019
SF LLL	SFLLL_1_2-V1.2.pdf	05/30/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.