Information Collection

Assurance Agreement

IC 274238 under ICR 202503-0570-006CF · OMB 0575-0201.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form RD 400-4 Assurance Agreement Assurance Agreement	Form
Form RD 400-4 Assurance Agreement Form RD 400-4 - Assurance Agreement.pdf	Form

IC Title:

Assurance Agreement

Agency IC Tracking Number:

0570-0075

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	Form RD 400-4				Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title: Privacy Act of 1974; System of Records

FR Citation: 89 FR 72820

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	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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