7 CFR 1776, Household Water Well System Grant Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form AD-1049 Certification Regarding Drug-Free Workplace Requirements	Form	Modified	Available
Form AD-1048 Certification Regarding Debarment	Form	Modified	Available
Form AD-1047 Certification Regarding Debarment-Primary	Form	Modified	Available
Form AD-1047 7 CFR 1776, "Household Water Well System Grant Program"	Form	Modified	Repair queued
SF424A-V1.0.pdf	Supplementary Document	Uploaded 2020-12-16	Available
SF424A-V1.0.pdf	Supplementary Document	Uploaded 2020-12-16	Repair queued
RD0400-0001_000500V01.pdf	Supplementary Document	Uploaded 2020-12-16	Available
RD0400-0001_000500V01.pdf	Supplementary Document	Uploaded 2020-12-16	Repair queued
HWWS 0572-0139 supp stmt OMB comments (RD response) clean.docx	Supporting Statement A	Uploaded 2021-12-13	Available
HWWS 0572-0139 supp stmt.docx	Supporting Statement A	Uploaded 2020-12-16	Repair queued
HWWS 0572-0139 spreadsheet 12.16.20.xls	Supplementary Document	Uploaded 2020-12-16	Available
HWWS 0572-0139 spreadsheet 12.16.20.xls	Supplementary Document	Uploaded 2020-12-16	Repair queued
ND_FormRD400-4_AssuranceAgreement.pdf	Supplementary Document	Uploaded 2020-12-16	Available
ND_FormRD400-4_AssuranceAgreement.pdf	Supplementary Document	Uploaded 2020-12-16	Repair queued
SF424_3_0-V3.0.pdf	Supplementary Document	Uploaded 2020-12-16	Available
SF424_3_0-V3.0.pdf	Supplementary Document	Uploaded 2020-12-16	Repair queued
7 CFR 1776.pdf	Supplementary Document	Uploaded 2020-12-16	Available
7 CFR 1776.pdf	Supplementary Document	Uploaded 2020-12-16	Missing upstream
7 USC 1926.pdf	Supplementary Document	Uploaded 2020-12-16	Available
7 USC 1926.pdf	Supplementary Document	Uploaded 2020-12-16	Repair queued
SF270-V1.0.pdf	Supplementary Document	Uploaded 2020-12-16	Available
SF270-V1.0.pdf	Supplementary Document	Uploaded 2020-12-16	Repair queued
SF425_2_0-V2.0.pdf	Supplementary Document	Uploaded 2020-12-16	Available
SF425_2_0-V2.0.pdf	Supplementary Document	Uploaded 2020-12-16	Repair queued
SFLLL_2_0-V2.0.pdf	Supplementary Document	Uploaded 2020-12-16	Available
SFLLL_2_0-V2.0.pdf	Supplementary Document	Uploaded 2020-12-16	Repair queued
SF424B-V1.1.pdf	Supplementary Document	Uploaded 2020-12-16	Available
SF424B-V1.1.pdf	Supplementary Document	Uploaded 2020-12-16	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
1889	7 CFR 1776, "Household Water Well System Grant Program"	Form	Modified	Certification Regarding Drug-Free Workplace Requirements
1889	7 CFR 1776, "Household Water Well System Grant Program"	Form	Modified	Certification Regarding Debarment
1889	7 CFR 1776, "Household Water Well System Grant Program"	Form	Modified	Certification Regarding Debarment-Primary
1889	7 CFR 1776, "Household Water Well System Grant Program"	Form	Modified

ICR Details

OMB Control No: 0572-0139	ICR Reference No: 202006-0572-006
Status: Active	Previous ICR Reference No: 201710-0572-001
Agency/Subagency: USDA/RUS	Agency Tracking No:
Title: 7 CFR 1776, Household Water Well System Grant Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/06/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/16/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2025	36 Months From Approved	01/31/2022
Responses	130	0	146
Time Burden (Hours)	666	0	770
Cost Burden (Dollars)	0	0	0

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Abstract: This collection consists of items required to apply for a Household Water Well System Grant and those items necessary for reporting purposes after grant award.

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Authorizing Statute(s): PL: Pub.L. 107 - 171 306e Name of Law: Grants to Non-Profit Organizations to Finance the Construction, Refurbishing, and Servicing, etc.
   US Code: 7 USC 1926e Name of Law: Consolidated Farm & Rural Development Act
  

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:
	85 FR 60960	09/29/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 81442	12/16/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
7 CFR 1776, "Household Water Well System Grant Program"	AD-1047, AD-1048, AD-1049	Certification Regarding Debarment-Primary ,   Certification Regarding Debarment ,   Certification Regarding Drug-Free Workplace Requirements

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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	130	146	0	0	-16	0
Annual Time Burden (Hours)	666	770	0	0	-104	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: The number of borrowers has remained constant over the prior three fiscal years averaging six. There have been no changes in the information collection requirements. Based on agency experience, there were minor agency adjustments in some grantees needing amended award amounts, having workplan changes, and submitting requests related to project duration extensions. This submission has a total of 130 responses. In the previous submission the total responses were 146. There has been an overall reduction in burden hours, from 770 to 666, due to a decrease in the average number grant awards.

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Annual Cost to Federal Government: $17,318

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.     No

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.     No

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? No

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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: 12/16/2020

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