Special Evaluation Assistance for Rural Communities & Household

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0505-0025 can be found here:

Documents and Forms

Document Name Document Type
Place holder for AD 3030 Series Forms.docx Other-Place Holder

Information Collection (IC) Details

IC Title:	Special Evaluation Assistance for Rural Communities & Household	Agency IC Tracking Number:	0572-0146 - State

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Place Holder			Place holder for AD 3030 Series Forms.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	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.