Information Collection

4284-b

IC 46673 under ICR 200701-0570-002 · OMB 0570-0053.

Documents and Forms

Document Name Document Type
Form RD 4284-01 4284-B Form
RD 4284-01 Grant Agreement 4284-01.pdf Form
SF- 424 Appl Fed Assistance.pdf SF 424 Application IC Document
SF - 424a Bdgt Info Non-Constr Prog..pdf SF 424A Budget Info Non-construction IC Document
SF -424b Assurances - Non-Constr Prog..pdf SF 424B Assurances Non-constructions IC Document
SF - 269 Financial Status Rpt - Long form.pdf SF 269 Financial Status Report (Long Form) IC Document
SF 269a Financial Status Rept..pdf SF 269A Financial Status Report (Short Form) IC Document
SF - 270 Request for Advcmt or Reimb.pdf SF 270 Req f/Advance or Reimbursement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	4284-B	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 4284, subpart B (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	RD 4284-01	Grant Agreement	4284-01.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: 700	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,160	8,160
Annual IC Time Burden (Hours)	53,235	53,235
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SF 424 Application	SF- 424 Appl Fed Assistance.pdf	04/23/2007
SF 424A Budget Info Non-construction	SF - 424a Bdgt Info Non-Constr Prog..pdf	04/23/2007
SF 424B Assurances Non-constructions	SF -424b Assurances - Non-Constr Prog..pdf	04/23/2007
SF 269 Financial Status Report (Long Form)	SF - 269 Financial Status Rpt - Long form.pdf	04/23/2007
SF 269A Financial Status Report (Short Form)	SF 269a Financial Status Rept..pdf	04/23/2007
SF 270 Req f/Advance or Reimbursement	SF - 270 Request for Advcmt or Reimb.pdf	04/23/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.