Information Collection

Water and Waste Loan and Grant Program - Private Sector

IC 187095 under ICR 201106-0572-002 · OMB 0572-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0121 can be found here:

Documents and Forms

Document Name Document Type
Form AD-1049 Water and Waste Loan and Grant Program - Private Sector Form and Instruction
AD-1049 Certf. Regarding Drug-Free Workplace ad-1049.pdf www.rurdev.usda.gov/rbs/coops/ad1049.pdf Form and Instruction
AD 1047 Certf. Regarding Debarment ad1047.pdf www.rurdev.usda.gov/rbs/oa/ad1047.pdf Form and Instruction
Bulletin 1780-12 Grant Agreement Bulletin 1780-12..pdf www.rurdev.usda.gov/SupportDocuments/UWP-rb-12.pdf Form and Instruction
Bulletin 1780-28 Loan Resolution, Security Agreement bulletin 1780-28.doc www.rurdev.usda.gov/SupportDocuments/UWP-bulletin%201780-28.pdf Form and Instruction
Bulletin 1780-27 Loan Resolution (Public Bodies) bulletin 1780-27.doc www.rurdev.usda.gov/RDU_Bulletins_Water_and_Environmental.html Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Water and Waste Loan and Grant Program - 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: 7 CFR 1780

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AD-1049	Certf. Regarding Drug-Free Workplace	ad-1049.pdf	http://www.rurdev.usda.gov/rbs/coops/ad1049.pdf	Yes	No	Fillable Printable
Form and Instruction	AD 1047	Certf. Regarding Debarment	ad1047.pdf	http://www.rurdev.usda.gov/rbs/oa/ad1047.pdf	Yes	No	Fillable Printable
Form and Instruction	Bulletin 1780-12	Grant Agreement	Bulletin 1780-12..pdf	http://www.rurdev.usda.gov/SupportDocuments/UWP-rb-12.pdf	Yes	No	Fillable Printable
Form and Instruction	Bulletin 1780-28	Loan Resolution, Security Agreement	bulletin 1780-28.doc	http://www.rurdev.usda.gov/SupportDocuments/UWP-bulletin%201780-28.pdf	Yes	No	Fillable Printable
Form and Instruction	Bulletin 1780-27	Loan Resolution (Public Bodies)	bulletin 1780-27.doc	http://www.rurdev.usda.gov/RDU_Bulletins_Water_and_Environmental.html	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: 119	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,095	2,766	4,329
Annual IC Time Burden (Hours)	14,815	1,552	13,263
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.