Information Collection

State, Local, Tribal Governments

IC 247144 under ICR 202105-0570-001 · OMB 0570-0074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0570-0074 can be found here:

Documents and Forms

Document Name Document Type
Form AD-1047 State, Local, Tribal Governments Form
RCDA IC List Placeholder.docx Other-Written Narratives
AD-1047 Certification Regarding Debarment, Suspension, and Other AD_1047.pdf Form
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi AD_1048.pdf Form
AD-1049 Certification Regarding Drug-Free Workplace Requirements AD_1049.pdf Form
AD-3031 Assurance Regarding Felony Conviction AD_3031_1_1-V1.1 (1).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents:	Number of Respondents for Small Entity:

Affected Public:

Percentage of Respondents Reporting Electronically:

		Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC
Annual IC Time Burden (Hours)
Annual IC Cost Burden (Dollars)

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.

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