Agriculture Innovation Centers

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0570-0045 can be found here:

Documents and Forms

Document Name Document Type
Form AD 1047 Agriculture Innovation Centers Form and Instruction
AD 1047 Certification Regarding Debarement, Suspension, and Othe AD1047-F-01-92.pdf Form and Instruction
AD 1048 Certification Regarding Debarement, Suspension, and Othe AD1048-F-01-92.pdf Form and Instruction
AD 1049 Certification Regarding Drug-Free Workplace Requirements AD1049-F-05-90.pdf Form and Instruction
RD Instruction 194 Certification for Contracts, Grants and Loans 1940q a1.pdf Form
SF-425 Federal Financial Report SF-425.pdf Form
SF 270 Request for Advance or Reimbursement sf270.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Agriculture Innovation Centers	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 4284-K (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AD 1047	Certification Regarding Debarement, Suspension, and Other Responsibility Matters	AD1047-F-01-92.pdf	Yes	No	Fillable Fileable
Form and Instruction	AD 1048	Certification Regarding Debarement, Suspension, and Other Responsibility Matters - Lower Tier	AD1048-F-01-92.pdf	Yes	No	Fillable Printable
Form and Instruction	AD 1049	Certification Regarding Drug-Free Workplace Requirements	AD1049-F-05-90.pdf	Yes	No	Fillable Printable
Form	RD Instruction 1940-Q, Exhibit A-1	Certification for Contracts, Grants and Loans	1940q a1.pdf	Yes	No	Fillable Printable
Form	SF-425	Federal Financial Report	SF-425.pdf	Yes	No	Fillable Printable
Form	SF 270	Request for Advance or Reimbursement	sf270.pdf	Yes	No	Fillable Printable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	Number of Respondents for Small Entity: 2

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

Percentage of Respondents Reporting Electronically: 60 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	-30	80
Annual IC Time Burden (Hours)	92	-48	140
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.