Information Collection

Water and Waste Loan and Grant Program - State, Local, Tribal Government

IC 43532 under ICR 202106-0572-001 · OMB 0572-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0121 can be found here:

2025-01-21 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD-1047 Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form and Instruction
Form AD-1047 Certification Regarding Debarment, Suspension, and Other Responsibility Matters Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form and Instruction
Form AD-1049 Certification Regarding Drug-Free Workplace Requirements Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form and Instruction
Form AD-1048 Certification Regarding Debarment-Lower Tier Coverd. Trans. Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form and Instruction
Form RD 1934-16 Pre-Construction Conference Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form
Form RUS 1780-7 Agreements for Professional Services Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form and Instruction
Form RUS 1780-9 Bulleti User Agreement Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form and Instruction
Form RD 1940-Q Exhibit Certifications for Contracts, Grants and Loans (Regarding Lobbying) Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form
Form Various Written Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form and Instruction
Form 1780-27 Loan Resolution Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form and Instruction
Form RUS Bulletin 1780- Water and Waste Systems Grant Agreement Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form and Instruction
Form RUS Bulletin 1780- Loan Resolution Security Agreement Water and Waste Loan and Grant Program - State, Local, Tribal Government	Form and Instruction
AD-1047 Certification Regarding Debarment, Suspension, and Other AD1047-F-01-92.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
AD-1047 Certification Regarding Debarment, Suspension, and Other AD1047-F-01-92.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
AD-1049 Certification Regarding Drug-Free Workplace Requirements AD1049-F-05-90.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
AD-1049 Certification Regarding Drug-Free Workplace Requirements AD1049-F-05-90.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
AD-1048 Certification Regarding Debarment-Lower Tier Coverd. Tra AD-1048 (Dec '15).pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
AD-1048 Certification Regarding Debarment-Lower Tier Coverd. Tra AD-1048 (Dec '15).pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
RD 1934-16 Pre-Construction Conference RD1924-16.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
RD 1934-16 Pre-Construction Conference RD1924-16.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
RUS 1780-7 Agreements for Professional Services RUS 1780-7 Bulletin and Written.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
RUS 1780-7 Agreements for Professional Services RUS 1780-7 Bulletin and Written.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
RUS 1780-9 Bulleti User Agreement RUS 1780-9 Bulletin and Written.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
RUS 1780-9 Bulleti User Agreement RUS 1780-9 Bulletin and Written.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form and Instruction
RD 1940-Q Exhibit Certifications for Contracts, Grants and Loans (Regardin RD 1940-Q_ExhA1.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
RD 1940-Q Exhibit Certifications for Contracts, Grants and Loans (Regardin RD 1940-Q_ExhA1.pdf www.rurdev.usda.gov/FormsAndPublications.html	Form
Various Written Non-Forms Written for 0572- 0121.docx	Form and Instruction
Various Written Non-Forms Written for 0572- 0121.docx	Form and Instruction
1780-27 Loan Resolution Bulletin 1780-27 _revised.pdf www.rd.usda.gov/directives/b-1780-27	Form and Instruction
1780-27 Loan Resolution Bulletin 1780-27 _revised.pdf www.rd.usda.gov/directives/b-1780-27	Form and Instruction
RUS Bulletin 1780- Water and Waste Systems Grant Agreement Bulletin 1780-12 _revised.pdf www.rd.usda.gov/files/UWP_Bulletin_1780-12.pdf	Form and Instruction
RUS Bulletin 1780- Water and Waste Systems Grant Agreement Bulletin 1780-12 _revised.pdf www.rd.usda.gov/files/UWP_Bulletin_1780-12.pdf	Form and Instruction
RUS Bulletin 1780- Loan Resolution Security Agreement Bulletin 1780-28_revised.pdf www.rd.usda.gov/sites/default/files/UWP-bulletin-1780-28.pdf	Form and Instruction
RUS Bulletin 1780- Loan Resolution Security Agreement Bulletin 1780-28_revised.pdf www.rd.usda.gov/sites/default/files/UWP-bulletin-1780-28.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Water and Waste Loan and Grant Program - State, Local, Tribal Government

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 1780

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AD-1047	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form and Instruction	AD-1049	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form and Instruction	AD-1048	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	RD 1934-16	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form and Instruction	RUS 1780-7	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form and Instruction	RUS 1780-9 Bulletin	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	RD 1940-Q Exhibit 1	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Printable Only
Form and Instruction	Various		Yes	No	Fillable Printable
Form and Instruction	1780-27	https://www.rd.usda.gov/directives/b-1780-27	Yes	No	Fillable Printable
Form and Instruction	RUS Bulletin 1780-12	https://www.rd.usda.gov/files/UWP_Bulletin_1780-12.pdf	Yes	No	Fillable Printable
Form and Instruction	RUS Bulletin 1780-28	https://www.rd.usda.gov/sites/default/files/UWP-bulletin-1780-28.pdf	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title: USDA/RDâ1 Current or Prospective Producers or Landowners, Applicants, Borrowers, Grantees, Tenants, and other participants in RD programs.

FR Citation: 84 FR 21315

Number of Respondents: 896

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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	61,782	7,414	1,473	52,895
Annual IC Time Burden (Hours)	163,203	18,215	2,459	142,529
Annual IC Cost Burden (Dollars)	0	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.

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