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Federal forms, ICRs, and supporting documents

Information Collection Request

Suspension and Debarment and Drug-Free Workplace Certifications

ICR 201902-0505-001 · OMB 0505-0027 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form AD-1047 Suspension and Debarment and Drug-Free Workplace Certifications Form and Instruction Modified Available
Copy of 0505-0027 2018 SDDFWP Certs - APPENDIX I.xlsx Supplementary Document Uploaded 2019-02-12 Repair queued
0505-0027 2018 SStmt Final (USDA SD DFWP Certs) 2-11-19.docx Supporting Statement A Uploaded 2019-02-12 Available
IC Document Collections
IC IDCollectionTypeStatusForm
217590 Suspension and Debarment and Drug-Free Workplace Certifications Form and Instruction Modified
ICR Details
0505-0027 201902-0505-001
Historical Active 201605-0505-001
USDA/OCFO
Suspension and Debarment and Drug-Free Workplace Certifications
Revision of a currently approved collection   No
Regular
Approved without change 04/10/2019
Retrieve Notice of Action (NOA) 02/12/2019
  Inventory as of this Action Requested Previously Approved
04/30/2022 36 Months From Approved 04/30/2019
1 0 1
1 0 1
0 0 0
To certify information on applicant suitability concerning distribution of financial assistance in compliance with Federal Suspension and Debarment and Drug-Free Workplace regulations.
US Code: 41 USC 8101 Name of Law: Drug-Free Workplace
  
None
Not associated with rulemaking
  83 FR 49353 10/01/2018
83 FR 66238 12/26/2018
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 1 1 0 0 0 0
Annual Time Burden (Hours) 1 1 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
    No
    Yes
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.
02/12/2019