Information Collection

7 CFR 1734, Subparts A,B,C, and D, Distance Learning and Telemedicine Loan and Grant Program

IC 43527 under ICR 202202-0572-002 · OMB 0572-0096.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD1049 7 CFR 1734, Subparts A,B,C, and D, Distance Learning and Telemedicine Loan and Grant Program	Form
This is a place holder for the following non-form reporting requirements.docx	Other-Non Form
AD1049 Certification Regarding Drug-Free Workplace AD_1049-V1.0.pdf	Form
AD-1047 Certification Regarding Debarment and Suspension AD_1047-V1.0.pdf	Form
Non Forms - Docume DLT Application guide 2021 fy2021_dlt_app_guide.pdf www.rd.usda.gov/sites/default/files/fy2021_dlt_app_guide.pdf	Form and Instruction

IC Title:

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 1734

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AD1049	Certification Regarding Drug-Free Workplace	AD_1049-V1.0.pdf		Yes	No	Fillable Printable
Form	AD-1047	Certification Regarding Debarment and Suspension	AD_1047-V1.0.pdf		Yes	No	Fillable Printable
Form and Instruction	Non Forms - Documents	DLT Application guide 2021	fy2021_dlt_app_guide.pdf	https://www.rd.usda.gov/sites/default/files/fy2021_dlt_app_guide.pdf	Yes	Yes	Fillable Printable
Other-Non Form			This is a place holder for the following non-form reporting requirements.docx		Yes	Yes	Fillable Printable

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: 300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 17 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,840	2,736	4,104
Annual IC Time Burden (Hours)	17,814	7,433	10,381
Annual IC Cost Burden (Dollars)	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.