Information Collection

7 CFR 1778, Emergency & Imminent Community Water Assistance Grants (state, local and tribal govts.)

IC 1827 under ICR 201902-0572-003 · OMB 0572-0110.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0110 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD 1047 7 CFR 1778, Emergency & Imminent Community Water Assistance Grants (state, local and tribal govts.)	Form
AD 1047 Certification Regarding Debarment, Suspension, and Other AD-1047.pdf	Form
AD 1048 Certification Regarding Debarment, Suspension, Ineligibi AD-1048.pdf	Form
AD 1049 Certification Regarding Drug-Free Workplace Requirements AD-1049.pdf	Form
RD 400-8 COMPLIANCE REVIEW RD 400-8.pdf	Form

IC Title:

7 CFR 1778, Emergency & Imminent Community Water Assistance Grants (state, local and tribal govts.)

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 1778

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AD 1047	Certification Regarding Debarment, Suspension, and Other Responsibility Matters	AD-1047.pdf	Yes	Yes	Fillable Printable
Form	AD 1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	AD-1048.pdf	Yes	Yes	Fillable Printable
Form	AD 1049	Certification Regarding Drug-Free Workplace Requirements (Grants)	AD-1049.pdf	Yes	Yes	Fillable Printable
Form	RD 400-8	COMPLIANCE REVIEW	RD 400-8.pdf	Yes	Yes	Fillable Printable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title: NA

FR Citation: 7 FR 1778

Number of Respondents: 26

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	209	109	100
Annual IC Time Burden (Hours)	1,462	1,262	200
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.