Form RD 1773-1 RD 1773-1 CPA Information

USDA-RD Form
RD 1773-1

Form Approved OMB
No. 0572-0095
Exp. mm/dd/yyyy

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:

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to
comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays
a currently valid OMB Control Number. The OMB Control Number for this information collection is 0572-0095. Public reporting for this collection
of information is estimated to be approximately 15 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, completing and reviewing the collection of information.
All responses to this collection of information are voluntary. However, in order to obtain or retain a benefit, the information in this form is
required. Rural Development has no plans to publish information collected under the provisions of this program. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection
Clearance Officer, Rural Development Innovation Center, Regulations Management Division at [email protected]