Information Collection

Tribal

IC 181552 under ICR 201006-0575-004 · OMB 0575-0180.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0575-0180 can be found here:

Documents and Forms

Document Name Document Type
Form AD-1047 Tribal Form
AD-1047 Certification Regarding Debarrment, etc. AD1047-F-01-92.pdf Form
AD-1048 Certification Regarding Debarrment, etc. - Lower Tier AD1048-F-01-92.pdf Form
SF-270 Request for Advance or Reimbursement sf270.pdf Form
AD-1049 Certification for Drug-Free Workplace AD1049-F-05-90.pdf Form
SF-LLL Disclosure of Lobbying Activites sflllin.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Tribal	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AD-1047	Certification Regarding Debarrment, etc.	AD1047-F-01-92.pdf	Yes	No	Fillable Printable
Form	AD-1048	Certification Regarding Debarrment, etc. - Lower Tier	AD1048-F-01-92.pdf	Yes	No	Fillable Printable
Form	SF-270	Request for Advance or Reimbursement	sf270.pdf	Yes	No	Fillable Printable
Form	AD-1049	Certification for Drug-Free Workplace	AD1049-F-05-90.pdf	Yes	No	Fillable Printable
Form	SF-LLL	Disclosure of Lobbying Activites	sflllin.pdf	Yes	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: 126	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	347	221	126
Annual IC Time Burden (Hours)	419	248	171
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.