Information Collection

Water and Waste Loan and Grant Program - Private Sector

IC 187095 under ICR 201711-0572-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 1047 Water and Waste Loan and Grant Program - Private Sector Form and Instruction
AD 1047 Certification Regarding Debarment Suspension and other R AD-1047 (Dec '15).pdf www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms Form and Instruction
AD 1049 Certification Regardin Drug-Free WorkPlace AD-1049 (Dec '15).pdf www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms Form and Instruction
AD 1048 Certification Regarding Debarment- Lower Tier Covered Tr AD-1048 (Dec '15).pdf www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms Form and Instruction
RD 1940-Q Exhibit Cert. for Contracts, Grants, and Loans (Regarding Lobbyi RD 1940-Q_ExhA1.pdf www.rd.usda.gov/files/IA_1940Q_ExhA1.pdf Form
RUS Bulletin 1780- Agreements for professional services RUS 1780-7 Bulletin and Written.pdf www.rd.usda.gov/files/UWP-rb-07.pdf Form and Instruction
RUS 1780-9 User agreement RUS 1780-9 Bulletin and Written.pdf www.rd.usda.gov/files/UWP-rb-09.pdf Form and Instruction
RUS Bulletin 1780- Grant Agreement RUS_Bulletin_1780-12.pdf www.rd.usda.gov/files/UWP_Bulletin_1780-12.pdf Form and Instruction
RUS Bulletin 1780- Loan Resolution (Public Bodies) RUS-bulletin 1780-27.pdf www.rd.usda.gov/files/UWP-bulletin%201780-27.pdf Form and Instruction
RUS Bulletin 1780- Loan Resolution, Security Agreement RUS-bulletin 1780-28.pdf www.rd.usda.gov/files/UWP-bulletin%201780-28.pdf Form and Instruction
RD 1934-16 RECORD OF PRE-CONSTRUCTION CONFERENCE RD1924-16.pdf forms.sc.egov.usda.gov/efcommon/eFileServices/eForms/RD1924-16.PDF Form

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 1047	Certification Regarding Debarment Suspension and other Responsibility Matters	AD-1047 (Dec '15).pdf	https://www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms	Yes	No	Fillable Printable
Form and Instruction	AD 1049	Certification Regardin Drug-Free WorkPlace	AD-1049 (Dec '15).pdf	https://www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms	Yes	No	Fillable Printable
Form and Instruction	AD 1048	Certification Regarding Debarment- Lower Tier Covered Trans	AD-1048 (Dec '15).pdf	https://www.ocio.usda.gov/policy-directives-records-forms/forms-management/approved-computer-generated-forms	Yes	No	Fillable Printable
Form	RD 1940-Q Exhibit A1	Cert. for Contracts, Grants, and Loans (Regarding Lobbying	RD 1940-Q_ExhA1.pdf	www.rd.usda.gov/files/IA_1940Q_ExhA1.pdf	Yes	No	Fillable Printable
Form and Instruction	RUS Bulletin 1780-7	Agreements for professional services	RUS 1780-7 Bulletin and Written.pdf	https://www.rd.usda.gov/files/UWP-rb-07.pdf	Yes	No	Fillable Fileable
Form and Instruction	RUS 1780-9	User agreement	RUS 1780-9 Bulletin and Written.pdf	https://www.rd.usda.gov/files/UWP-rb-09.pdf	Yes	No	Fillable Printable
Form and Instruction	RUS Bulletin 1780-12	Grant Agreement	RUS_Bulletin_1780-12.pdf	https://www.rd.usda.gov/files/UWP_Bulletin_1780-12.pdf	Yes	No	Fillable Printable
Form and Instruction	RUS Bulletin 1780-27	Loan Resolution (Public Bodies)	RUS-bulletin 1780-27.pdf	www.rd.usda.gov/files/UWP-bulletin%201780-27.pdf	Yes	No	Fillable Printable
Form and Instruction	RUS Bulletin 1780-28	Loan Resolution, Security Agreement	RUS-bulletin 1780-28.pdf	www.rd.usda.gov/files/UWP-bulletin%201780-28.pdf	Yes	No	Fillable Printable
Form	RD 1934-16	RECORD OF PRE-CONSTRUCTION CONFERENCE	RD1924-16.pdf	https://forms.sc.egov.usda.gov/efcommon/eFileServices/eForms/RD1924-16.PDF	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 124	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	7,214	30	7,184
Annual IC Time Burden (Hours)	13,810	-1,171	14,981
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.