Suspension and Debarment and Drug-Free Workplace Certifications

OMB 0505-0027

To certify information on applicant suitability concerning distribution of financial assistance in compliance with Federal Suspension and Debarment and Drug-Free Workplace regulations.

The latest form for Suspension and Debarment and Drug-Free Workplace Certifications expires 2022-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form AD-1047 Suspension and Debarment and Drug-Free Workplace Certifications Form and Instruction
Form AD-1047 Suspension and Debarment and Drug-Free Workplace Certifications Form and Instruction
Change Justifications - OMB Control Nos. 0505-0027_1.4.23_v1.docx Justification for No Material/Nonsubstantive Change
Change Justifications - OMB Control Nos. 0505-0027_1.4.23_v1.docx Justification for No Material/Nonsubstantive Change
00505-0027-22 SStmt Final -USDA SD DFWP Certs. 090822.docx Supporting Statement A
00505-0027-22 SStmt Final -USDA SD DFWP Certs. 090822.docx Supporting Statement A
Suspension and Debarment and Drug-Free Workplace Certifications Form and Instruction
Suspension and Debarment and Drug-Free Workplace Certifications Form and Instruction

202301-0505-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-01-05
202204-0505-001 Approved with change	Revision of a currently approved collection	2022-04-29
201910-0505-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2019-10-17
201907-0505-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2019-07-11
201902-0505-001 Approved without change	Revision of a currently approved collection	2019-02-12
201605-0505-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-05-17
201507-0505-001 Approved with change	New collection (Request for a new OMB Control Number)	2015-07-23