Technical Assistance Program - American Indian Tribes

Technical Assistance Program - 7 CFR 1775

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0112 can be found here:

Documents and Forms

Document Name Document Type
Form AD-1048 Technical Assistance Program - American Indian Tribes Form and Instruction
AD-1047 Certification Regarding Debarment, Suspension, and Other AD_1047-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1 Form and Instruction
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi AD_1048-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1 Form and Instruction
AD - 1049 Certification Regarding Drug-Free Workplace Requirements AD_1049-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1 Form and Instruction

Information Collection (IC) Details

IC Title:	Technical Assistance Program - American Indian Tribes	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 1775

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AD-1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	AD_1048-V1.0.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	AD - 1049	Certification Regarding Drug-Free Workplace Requirements (Grants)	AD_1049-V1.0.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	AD-1047	Certification Regarding Debarment, Suspension, and Other Responsibility Matters	AD_1047-V1.0.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	83	-220	303
Annual IC Time Burden (Hours)	354	-920	1,274
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.