Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants & Awardees

Forms and Documents

Document Name	Status
Form AD 3031 7 CFR 1775 Technical assistance Program (0572-0112) Form and Instruction	New
Form AD 3030 Technical assistance Program 7 CFR 1775 (0572-0112) Form and Instruction	New
Justification for Change New Exp Date.docx Justification for No Material/Nonsubstantive Change	2016-09-15
AD-3031-FS FY 12-13-14 Assurance for Felony and Tax_0.pdf Supplementary Document	2016-09-15
AD-3030-FS - FY 12-13-14 Reprsntn Reg Felony and Tax Delinquent.pdf Supplementary Document	2016-09-15
AD-3031-Y Assurance for Felony and Tax.pdf Supplementary Document	2016-09-15
AD-3030-Y Reprsntn Reg Felony and Tax Delinquent.pdf Supplementary Document	2016-09-15
AD-3031 ASSURANCE REGARDING FELONY CONVICTION.pdf Supplementary Document	2016-09-15
AD-3030 REPRESENTATIONS REGARDING FELONY CONVICTION.pdf Supplementary Document	2016-09-15
0505-0025 Generic Renewal Final SuptStmt 02 25 16.docx Supporting Statement A	2016-04-21
0505-0025 - Generic renewal Spreadsheet -Final.xlsm Supplementary Document	2016-04-21

IC Document Collections

IC ID	Document Title	Status
228892	7 CFR 1775 Technical assistance Program (0572-0112) Form and Instruction	New
228826	Technical assistance Program 7 CFR 1775 (0572-0112) Form and Instruction	New
225000	AD-3030 (Distance Learning & Telemedicine Loan & Grant Program) Other-Place Holder - AD-3030 (15 min.)	New
224963	Rural Cooperative Development Grant Program Other-Place Holder AD-3030 (.25 min)	New
223783	AMS Grant Programs Other-Place Holder	New
223571	Special Evaluation Assistance for Rural Communities & Household Other-Place Holder	New

ICR Details

OMB Control No: 0505-0025	ICR Reference No: 201609-0505-001
Status: Historical Active	Previous ICR Reference No: 201604-0505-001
Agency/Subagency: USDA/OCFO	Agency Tracking No:
Title: Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants & Awardees
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/2016
	Date Received in OIRA: 09/15/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	04/30/2019	04/30/2019
Responses	2,256,097	0	2,256,097
Time Burden (Hours)	564,024	0	564,024
Cost Burden (Dollars)	0	0	0

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Abstract: Information collected will be used to evaluate corporate applicants and awardees felony conviction and tax delinquency status prior to entering into new non-procurement contracts, grants, loans, loan guarantees, cooperative agreements and some memoranda of agreement. The information is needed to ensure fiscal year funds are not inappropriately disbursed.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: PL: Pub.L. 114 - 113 745 and 746 Name of Law: Consolidated Appropriations Act, 2016

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 61334	10/13/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 9420	02/25/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Rural Cooperative Development Grant Program
AMS Grant Programs
Technical assistance Program 7 CFR 1775 (0572-0112)	AD 3030	Representation Regarding Felony Conviction and Tax Deliniquent Status - Corporate
7 CFR 1775 Technical assistance Program (0572-0112)	AD 3031	Assurances Regarding Felony Conviction and Tax Delinquent Status - Corporate
AD-3030 (Distance Learning & Telemedicine Loan & Grant Program)
Special Evaluation Assistance for Rural Communities & Household

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,256,097	2,256,097	0	0	0	0
Annual Time Burden (Hours)	564,024	564,024	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $49,478,800

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/15/2016

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