IMPACT ASSESSMENT QUESTIONNAIRE: COVID-19 RESPONSE VERSION (DFC-007a) |
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OMB No. 3015-0009 |
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Expiration Date: 8-31-2022 |
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United States International Development Finance Corporation |
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1100 New York Avenue, NW Washington, DC 20527-0001 |
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An Agency of the United States Government |
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Responses to questions which call for estimates or projections should take the form of good faith statements made to the best of the applicant’s knowledge and belief. Statements of fact provided to DFC in this document must be accurate as of the date of submission. Anyone who knowingly makes a false statement with the intent to influence DFC’s guarantees, loans, or other investments may be criminally prosecuted. Such false statements are also grounds for DFC to terminate a commitment or declare a contract default. These rights are in addition to any other rights or remedies available to United States government. Neither submission nor acceptance of this application implies that the proposed transaction is eligible for support or that support will be provided. |
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Information provided in this form will be deemed designated as “confidential commercial information” in accordance with Freedom of Information Act (FOIA) regulations at 22 C.F.R. Part 706, and will be treated as such to the extent permitted by applicable law. |
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Paperwork Reduction Act Notice: This information is required to obtain benefits. Federal agencies may not collect information unless a valid OMB Control Number with an expiration date that has not expired is displayed. The public reporting burden for this collection of information is estimated to average 2.8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to Agency Clearance Officer, Records Management, United States International Development Finance Corporation, 1100 New York Avenue, NW, Washington, DC, 20527 and to the DFC Desk Officer at the Office of Information and Regulatory Affairs, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, DC 20503. |
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SPECIAL NOTE: This off-line Excel version of the DFC-007 is only for use by applicants whose transactions DFC has designated as being responsive to the impacts associated with the COVID-19 pandemic. Do not use this version unless your DFC contact has instructed you to do so. All other DFC applicants must complete the DFC-007 through the online DFC Forms portal and answer all applicable questions in the form. Your DFC contact can generate a DFC-007 for you in the online system. |