Information Collection

Mutual and Self-Help Housing - State, Local, and Tribal

IC 180297 under ICR 200705-0575-001 · OMB 0575-0191.

Documents and Forms

Document Name Document Type
Form AD-1047 Mutual and Self-Help Housing - State, Local, and Tribal Form
AD-1047 Certification Regarding Debarment, Suspension, and Other AD1047-F-01-92.pdf Form
AD-1049 CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS AD1049-F-05-90.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Mutual and Self-Help Housing - State, Local, and Tribal	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 3551

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, Suspension, and Other Responsibility Matters - Primary Covered Transactions	AD1047-F-01-92.pdf		Yes	No	Fillable Printable
Form	AD-1049	CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS) ALTERNATIVE I - FOR GRANTEES OTHER THAN INDIVIDUALS	AD1049-F-05-90.pdf		Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	407	407
Annual IC Time Burden (Hours)	1,870	1,870
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.