Information Collection

non-profit / private sector

IC 209670 under ICR 202101-0572-002 · OMB 0572-0150.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD -1047 non-profit / private sector	Form
Form AD -1047 Certification Regarding Debarment non-profit / private sector	Form
Form AD- 1048 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Transaction non-profit / private sector	Form
Form AD - 1049 Certification Regarding Drug-Free Workplace non-profit / private sector	Form
Form RD Instruction 194 Certification for Contracts, Grants and Loans REgarding Lobbying non-profit / private sector	Form and Instruction
Form RD 400-1 Equal Opportunity Agreement non-profit / private sector	Form
Form RD 400-4 Assurance Agreement non-profit / private sector	Form
Form RD 442-22 Opinion of COunsel relative to RIght-of-Way & Easments non-profit / private sector	Form
Form RD 1942-46 Letter of Intent to Meet Conditions non-profit / private sector	Form
Form SF 424 Application for Federal Assistance non-profit / private sector	Form and Instruction
Form RUS Bulletin 1780- RUS Bulletin 1780-12 non-profit / private sector	Form and Instruction
RAVG SOA Grant Agreement non-profit / private sector	Form
RAVG ANTHC Grant Agreement non-profit / private sector	Form
AD -1047 Certification Regarding Debarment AD-1047 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
AD -1047 Certification Regarding Debarment AD-1047 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
AD- 1048 Certification Regarding Debarment, Suspension, Ineligibi AD-1048 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
AD- 1048 Certification Regarding Debarment, Suspension, Ineligibi AD-1048 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
AD - 1049 Certification Regarding Drug-Free Workplace AD-1049 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
AD - 1049 Certification Regarding Drug-Free Workplace AD-1049 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
RD Instruction 194 Certification for Contracts, Grants and Loans REgarding RD Instruction 1940Q A-1 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
RD Instruction 194 Certification for Contracts, Grants and Loans REgarding RD Instruction 1940Q A-1 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
RD 400-1 Equal Opportunity Agreement RD400-1 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
RD 400-1 Equal Opportunity Agreement RD400-1 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
RD 400-4 Assurance Agreement RD 400-4 2018.PDF www.rurdev.usda.gov/FormsAndPublications.html	Form
RD 400-4 Assurance Agreement RD 400-4 2018.PDF www.rurdev.usda.gov/FormsAndPublications.html	Form
RD 442-22 Opinion of COunsel relative to RIght-of-Way & Easments RD0442-0022 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
RD 442-22 Opinion of COunsel relative to RIght-of-Way & Easments RD0442-0022 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
RD 1942-46 Letter of Intent to Meet Conditions RD1942-46 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
RD 1942-46 Letter of Intent to Meet Conditions RD1942-46 2018.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
SF 424 Application for Federal Assistance SF424 FORM AND INSTRUCTION.pdf www.grants.gov	Form and Instruction
SF 424 Application for Federal Assistance SF424 FORM AND INSTRUCTION.pdf www.grants.gov	Form and Instruction
RUS Bulletin 1780- RUS Bulletin 1780-12 RUS_Bulletin_1780-12.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
RUS Bulletin 1780- RUS Bulletin 1780-12 RUS_Bulletin_1780-12.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
RAVG SOA Grant Agreement RAVG SOA Grant Agreement FINAL.docx www.rurdev.usda.gov/FormsAndPublications.html	Form
RAVG SOA Grant Agreement RAVG SOA Grant Agreement FINAL.docx www.rurdev.usda.gov/FormsAndPublications.html	Form
RAVG ANTHC Grant Agreement RAVG ANTHC Grant Agreement FINAL.doc www.rurdev.usda.gov/FormsAndPublications.html	Form
RAVG ANTHC Grant Agreement RAVG ANTHC Grant Agreement FINAL.doc www.rurdev.usda.gov/FormsAndPublications.html	Form
SF424C_2_0-V2.0 (1).pdf SF 424C - Budget Information - Construciton Programs	IC Document
SF424C_2_0-V2.0 (1).pdf SF 424C - Budget Information - Construciton Programs	IC Document
SF424D-V1.1 2018.pdf SF 424D - Assurances - Construction Programs	IC Document
SF424D-V1.1 2018.pdf SF 424D - Assurances - Construction Programs	IC Document
SFLLL_1_2-V1.2 2018.pdf SF LLL - Disclosure of Lobbying Activities	IC Document
SFLLL_1_2-V1.2 2018.pdf SF LLL - Disclosure of Lobbying Activities	IC Document
SF424A-V1.0 2018.pdf SF-424A, “Budget Information--Non-Construction Programs	IC Document
SF424A-V1.0 2018.pdf SF-424A, “Budget Information--Non-Construction Programs	IC Document
SF424B-V1.1 2018.pdf SF-424B, “Assurances--Non-construction Programs	IC Document
SF424B-V1.1 2018.pdf SF-424B, “Assurances--Non-construction Programs	IC Document
UP_ET_form_266 2018.pdf RUS Form 266 “Compliance Assurance	IC Document
UP_ET_form_266 2018.pdf RUS Form 266 “Compliance Assurance	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

non-profit / private sector

Agency IC Tracking Number:

0572

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 1784

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AD -1047	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	AD- 1048	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	AD - 1049	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form and Instruction	RD Instruction 1940Q A-1	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	RD 400-1	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	RD 400-4	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	RD 442-22	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	RD 1942-46	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form and Instruction	SF 424	http://www.grants.gov	Yes	No	Fillable Printable
Form and Instruction	RUS Bulletin 1780-12	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	None	http://www.rurdev.usda.gov/FormsAndPublications.html	No		Fillable Printable
Form	None	http://www.rurdev.usda.gov/FormsAndPublications.html	No		Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-138	138
Annual IC Time Burden (Hours)	-188	188
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SF 424C - Budget Information - Construciton Programs		09/05/2018
SF 424D - Assurances - Construction Programs		09/05/2018
SF LLL - Disclosure of Lobbying Activities		09/05/2018
SF-424A, âBudget Information--Non-Construction Programs		09/05/2018
SF-424B, âAssurances--Non-construction Programs		09/05/2018
RUS Form 266 âCompliance Assurance		09/05/2018

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

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