Information Collection

Suspension and Debarment and Drug-Free Workplace Certifications

IC 217590 under ICR 201902-0505-001 · OMB 0505-0027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0505-0027 can be found here:

Documents and Forms

Document Name Document Type
Form AD-1047 Suspension and Debarment and Drug-Free Workplace Certifications Form and Instruction
AD-1047 Certification Regarding Debarment, Suspension, and Other AD-1047 (Dec '18).docx Form and Instruction
AD-1048 Cdrtification Regarding Debarment, Suspension, Ineligibi AD-1048 (Dec '18).docx Form and Instruction
AD-1049 Certification Regarding Drug-Free Workplace Requirements AD-1049 (Dec '18).docx Form and Instruction
AD-1050 Certofocatopm Regarding Drug-Free Workplace Requirements AD-1050 (Dec '18).docx Form and Instruction
AD-1052 Certification Regarding Drug-Free Workplace State and St AD-1052 (Dec '18).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Suspension and Debarment and Drug-Free Workplace Certifications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AD-1047	Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary COvered Transactions	AD-1047 (Dec '18).docx	Yes	No	Fillable Fileable
Form and Instruction	AD-1048	Cdrtification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions	AD-1048 (Dec '18).docx	Yes	No	Fillable Fileable
Form and Instruction	AD-1049	Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - For Grantee Other Than Individuals	AD-1049 (Dec '18).docx	Yes	No	Fillable Fileable
Form and Instruction	AD-1050	Certofocatopm Regarding Drug-Free Workplace Requirements (Grants) Alternative II - For Grantees Who are Individuals	AD-1050 (Dec '18).docx	Yes	No	Fillable Fileable
Form and Instruction	AD-1052	Certification Regarding Drug-Free Workplace State and State Agencies, Federal Fiscal Year	AD-1052 (Dec '18).docx	Yes	No	Fillable Fileable

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	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.