Form RD 1773-1 RD 1773-1 CPA Information

USDA-RD Form
RD 1773-1

Form Approved OMB
No. 0572-0095
Exp. 2/28/2022

United States Department of Agriculture
Rural Development

CERTIFIED PUBLIC ACCOUNTANT INFORMATION
1. Legal Name of Borrower or Awardee:

2. RUS ID of Borrower or Awardee:

3. Certified Public Accountant (CPA) Firm Name:

4. CPA Firm Physical Address:

Street

State

City

Zip Code

5. CPA Firm Point of Contact (PoC) Name:

6. CPA Firm Email Address

6a. CPA Firm PoC Email Address:

7. CPA Firm Phone Number:

7a. CPA Firm PoC Phone Number:

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0572-0095. The time required to complete this information collection
is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.