Information Collection

Water and Waste Loan and Grant Program - State, Local, Tribal Government

IC 43532 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⚠️ Notice: This information collection may be referencing outdated material.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 RUS Bulletin 1780- Water and Waste Loan and Grant Program - State, Local, Tribal Government Form and Instruction
RUS Bulletin 1780- Loan Resolution Bulletin 1780-27.pdf http:www.rurdev.usda.gov/RDU_Bulletins.html Form and Instruction
RUS Bulletin 1780- Water and Waste Systems Grant Agreement Bulletin 1780-12.pdf http:www.rurdev.usda.gov?RDU_Bulletins.html Form and Instruction
RUS Bulletin 1780- Loan Resolution Security Agreement Bulletin 1780-28.pdf http:www.rurdev.usda.gov/RDU_Bulletins.html Form and Instruction
AD-1047 Certification Regarding Debarment, Suspension, and Other AD1047-F-01-92.pdf www.rurdev.usda.gov/FormsAndPublications.html Form and Instruction
AD-1049 Certification Regarding Drug-Free Workplace Requirements AD1049-F-05-90.pdf www.rurdev.usda.gov/FormsAndPublications.html Form and Instruction
AD-1048 Certification Regarding Debarment-Lower Tier Coverd. Tra AD-1048 (Dec '15).pdf www.rurdev.usda.gov/FormsAndPublications.html Form and Instruction
RD 1934-16 Pre-Construction Conference RD1924-16.pdf www.rurdev.usda.gov/FormsAndPublications.html Form
RUS 1780-7 Agreements for Professional Services RUS 1780-7 Bulletin and Written.pdf www.rurdev.usda.gov/FormsAndPublications.html Form and Instruction
RUS 1780-9 Bulleti User Agreement RUS 1780-9 Bulletin and Written.pdf www.rurdev.usda.gov/FormsAndPublications.html Form and Instruction
RD 1940-Q Exhibit Certifications for Contracts, Grants and Loans (Regardin RD 1940-Q_ExhA1.pdf www.rurdev.usda.gov/FormsAndPublications.html Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Water and Waste Loan and Grant Program - State, Local, Tribal Government	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	RUS Bulletin 1780-27	Loan Resolution	Bulletin 1780-27.pdf	http:www.rurdev.usda.gov/RDU_Bulletins.html	Yes	No	Fillable Printable
Form and Instruction	RUS Bulletin 1780-12	Water and Waste Systems Grant Agreement	Bulletin 1780-12.pdf	http:www.rurdev.usda.gov?RDU_Bulletins.html	Yes	No	Fillable Printable
Form and Instruction	RUS Bulletin 1780-28	Loan Resolution Security Agreement	Bulletin 1780-28.pdf	http:www.rurdev.usda.gov/RDU_Bulletins.html	Yes	No	Fillable Printable
Form and Instruction	AD-1047	Certification Regarding Debarment, Suspension, and Other Responsibility Matters	AD1047-F-01-92.pdf	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form and Instruction	AD-1049	Certification Regarding Drug-Free Workplace Requirements	AD1049-F-05-90.pdf	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form and Instruction	AD-1048	Certification Regarding Debarment-Lower Tier Coverd. Trans.	AD-1048 (Dec '15).pdf	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	RD 1934-16	Pre-Construction Conference	RD1924-16.pdf	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form and Instruction	RUS 1780-7	Agreements for Professional Services	RUS 1780-7 Bulletin and Written.pdf	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form and Instruction	RUS 1780-9 Bulletin	User Agreement	RUS 1780-9 Bulletin and Written.pdf	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Fillable Printable
Form	RD 1940-Q Exhibit 1	Certifications for Contracts, Grants and Loans (Regarding Lobbying)	RD 1940-Q_ExhA1.pdf	http://www.rurdev.usda.gov/FormsAndPublications.html	Yes	No	Printable Only

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: 741	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	52,895	8,894	44,001
Annual IC Time Burden (Hours)	142,529	50,507	92,022
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.