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Verification of Occupancy of Domestic Farm Laborer
ICR 202605-0575-002 · OMB 0575-0189 · Object 169304800.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | Verification of Occupancy of Domestic Farm Laborer |
| Last Modified By | Acrobat PDFMaker 21 for Word |
| File Modified | 2021-07-09 |
| File Created | 2021-07-09 |
| Conversion State | complete |
Extracted Text
Close Save Submit FORMAPPROVED OMB NO. 0575-0189 Exp. Date: MM/DD/YY Form RD3560-43 (02-05) UNITED STATES DEPARTMENT OF AGRICULTURE RURAL HOUSING SERVICE VERIFICATION OF OCCUPANCY OF DOMESTIC FARM LABORER On (Insert date of initial occupancy) house owned by , , I/We became the occupant(s) of the labor (Insert name of owner/borrower) Yes No This dwelling is provided as a condition of my farm labor employment. Yes No I pay my own utilities: (Check all that apply) Electric Water Sewer Fuel (Oil/Gas/Wood) Garbage & Trash Removal Other (Specify) I will notify the Rural Housing Service should the above circumstances change. (Signature of Tenant/Occupant) (Date) 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 0575-0189. 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 under Section 515 Rural Rental Housing, which includes Congregate Housing, Group Homes, and Rural Cooperative Housing. 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] Close Save Submit