OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants & Awardees

ICR 201609-0505-001 · OMB 0505-0025 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form AD 3031 7 CFR 1775 Technical assistance Program (0572-0112) Form and Instruction New Available
Form AD 3030 Technical assistance Program 7 CFR 1775 (0572-0112) Form and Instruction New Available
Justification for Change New Exp Date.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-09-15 Available
AD-3031-FS FY 12-13-14 Assurance for Felony and Tax_0.pdf Supplementary Document Uploaded 2016-09-15 Repair queued
AD-3030-FS - FY 12-13-14 Reprsntn Reg Felony and Tax Delinquent.pdf Supplementary Document Uploaded 2016-09-15 Available
AD-3031-Y Assurance for Felony and Tax.pdf Supplementary Document Uploaded 2016-09-15 Available
AD-3030-Y Reprsntn Reg Felony and Tax Delinquent.pdf Supplementary Document Uploaded 2016-09-15 Available
AD-3031 ASSURANCE REGARDING FELONY CONVICTION.pdf Supplementary Document Uploaded 2016-09-15 Available
AD-3030 REPRESENTATIONS REGARDING FELONY CONVICTION.pdf Supplementary Document Uploaded 2016-09-15 Available
0505-0025 Generic Renewal Final SuptStmt 02 25 16.docx Supporting Statement A Uploaded 2016-04-21 Repair queued
0505-0025 - Generic renewal Spreadsheet -Final.xlsm Supplementary Document Uploaded 2016-04-21 Available
IC Document Collections
IC IDCollectionTypeStatusForm
228892 7 CFR 1775 Technical assistance Program (0572-0112) Form and Instruction New
228826 Technical assistance Program 7 CFR 1775 (0572-0112) Form and Instruction New
225000 AD-3030 (Distance Learning & Telemedicine Loan & Grant Program) Other-Place Holder - AD-3030 (15 min.) New
224963 Rural Cooperative Development Grant Program Other-Place Holder AD-3030 (.25 min) New
223783 AMS Grant Programs Other-Place Holder New
223571 Special Evaluation Assistance for Rural Communities & Household Other-Place Holder New
ICR Details
0505-0025 201609-0505-001
Historical Active 201604-0505-001
USDA/OCFO
Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants & Awardees
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 09/15/2016
Retrieve Notice of Action (NOA) 09/15/2016
  Inventory as of this Action Requested Previously Approved
04/30/2019 04/30/2019 04/30/2019
2,256,097 0 2,256,097
564,024 0 564,024
0 0 0
Information collected will be used to evaluate corporate applicants and awardees felony conviction and tax delinquency status prior to entering into new non-procurement contracts, grants, loans, loan guarantees, cooperative agreements and some memoranda of agreement. The information is needed to ensure fiscal year funds are not inappropriately disbursed.
None
PL: Pub.L. 114 - 113 745 and 746 Name of Law: Consolidated Appropriations Act, 2016
Not associated with rulemaking
  80 FR 61334 10/13/2015
81 FR 9420 02/25/2016
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,256,097 2,256,097 0 0 0 0
Annual Time Burden (Hours) 564,024 564,024 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$49,478,800
No
No
No
No
No
Uncollected
Martha Burton 202 205-6182
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/15/2016