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7 CFR 1776, "Household Water Well System Grant Program"
7 CFR 1776, Household Water Well System Grant Program
OMB: 0572-0139
IC ID: 1889
OMB.report
USDA/RUS
OMB 0572-0139
ICR 202006-0572-006
IC 1889
( )
Documents and Forms
Document Name
Document Type
Form AD-1047
7 CFR 1776, "Household Water Well System Grant Program"
Form
AD-1047 Certification Regarding Debarment-Primary
AD_1047-V1.0.pdf
www.ocio.usda.gov/document/ad-1047
Form
AD-1048 Certification Regarding Debarment
AD_1048-V1.0.pdf
www.ocio.usda.gov/document/ad-1048
Form
AD-1049 Certification Regarding Drug-Free Workplace Requirements
AD_1049_2_0-V2.0.pdf
www.ocio.usda.gov/document/ad-1049
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
7 CFR 1776, "Household Water Well System Grant Program"
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 1776
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
AD-1047
Certification Regarding Debarment-Primary
AD_1047-V1.0.pdf
https://www.ocio.usda.gov/document/ad-1047
Yes
No
Fillable Printable
Form
AD-1048
Certification Regarding Debarment
AD_1048-V1.0.pdf
https://www.ocio.usda.gov/document/ad-1048
Yes
No
Fillable Printable
Form
AD-1049
Certification Regarding Drug-Free Workplace Requirements
AD_1049_2_0-V2.0.pdf
https://www.ocio.usda.gov/document/ad-1049
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
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:
5
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
50 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
130
0
0
-16
0
146
Annual IC Time Burden (Hours)
666
0
0
-104
0
770
Annual IC Cost Burden (Dollars)
0
0
0
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.