Information Collection

SEARCH - Private Sector

IC 191564 under ICR 201005-0572-003 · OMB 0572-0146.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0146 can be found here:

Documents and Forms

Document Name Document Type
Form AD 1047 SEARCH - Private Sector Form
AD 1047 Certification Regarding Debarment ad1047.pdf www.usda.gov/rus/water/wwforms.htm Form
AD 1049 Certification for a Drug Free Workplace ad1049.pdf www.usda.gov/rus/water/wwforms.htm Form and Instruction
AD 1048 Certification regarding Debarment AD1048.pdf www.usda.gov/rus/water/wwforms.htm Form and Instruction
SF 270 Req. for Adv. or Reimbursement sf270.pdf www.whitehouse.gov/omb/grants/sf270.pdf Form and Instruction
SF 269a -Short for Financial Status Report sf269a.pdf www.whitehouse.gov/omb/grants/sf269a.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SEARCH - Private Sector	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	ad1047.pdf	http://www.usda.gov/rus/water/wwforms.htm	Yes	No	Fillable Printable
Form and Instruction	AD 1049	Certification for a Drug Free Workplace	ad1049.pdf	http://www.usda.gov/rus/water/wwforms.htm	Yes	No	Fillable Printable
Form and Instruction	AD 1048	Certification regarding Debarment	AD1048.pdf	http://www.usda.gov/rus/water/wwforms.htm	Yes	No	Fillable Printable
Form and Instruction	SF 270	Req. for Adv. or Reimbursement	sf270.pdf	www.whitehouse.gov/omb/grants/sf270.pdf	No		Fillable Printable
Form and Instruction	SF 269a -Short form	Financial Status Report	sf269a.pdf	www.whitehouse.gov/omb/grants/sf269a.pdf	No		Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 47	Number of Respondents for Small Entity: 43

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	508	508
Annual IC Time Burden (Hours)	1,082	1,082
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.