Information Collection

Technical Assistance Program - Private Sector

IC 1830 under ICR 202006-0572-003 · OMB 0572-0112.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0112 can be found here:

2025-01-21 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
Form AD-1047 Technical Assistance Program - Private Sector Form and Instruction
Form AD-1047 Certification Regarding Debarment, Suspension, and Other Responsibility Matters Technical Assistance Program - Private Sector Form and Instruction
Form AD-1048 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Technical Assistance Program - Private Sector Form and Instruction
Form AD-1049 Certification Regarding Drug-Free Workplace Requirements (Grants) Technical Assistance Program - Private Sector Form and Instruction
AD-1047 Certification Regarding Debarment, Suspension, and Other AD_1047-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1 Form and Instruction
AD-1047 Certification Regarding Debarment, Suspension, and Other AD_1047-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1 Form and Instruction
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi AD_1048-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1 Form and Instruction
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi AD_1048-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1 Form and Instruction
AD-1049 Certification Regarding Drug-Free Workplace Requirements AD_1049-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1 Form and Instruction
AD-1049 Certification Regarding Drug-Free Workplace Requirements AD_1049-V1.0.pdf www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1 Form and Instruction
CFR-2014-title7-vol12-part1775.pd.pdf CFR - Title 7 part 1775 IC Document
CFR-2014-title7-vol12-part1775.pd.pdf CFR - Title 7 part 1775 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Technical Assistance 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 1775

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-V1.0.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	AD-1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	AD_1048-V1.0.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable
Form and Instruction	AD-1049	Certification Regarding Drug-Free Workplace Requirements (Grants)	AD_1049-V1.0.pdf	https://www.grants.gov/web/grants/forms/sf-424-family.html#sortby=1	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title: USDA/RDâ1 Current or Prospective Producers or Landowners, Applicants, Borrowers, Grantees, Tenants, and other participants in RD programs	FR Citation: 84 FR 21315

Number of Respondents: 61	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 2 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,302	91	1,211
Annual IC Time Burden (Hours)	5,538	443	5,095
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
CFR - Title 7 part 1775	CFR-2014-title7-vol12-part1775.pd.pdf	06/01/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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