Information Collection

Assurance Agreement

IC 250237 under ICR 202111-0575-001 · OMB 0575-0201.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0575-0201 can be found here:

Documents and Forms

Document Name Document Type
Form Form RD 400-4 Assurance Agreement Form
Form RD 400-4 Assurance Agreement Form RD 400-4 - Assurance Agreement.pdf Form
Form RD 400-4 Assurance Agreement Form RD 400-4 - Assurance Agreement.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Assurance Agreement	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form RD 400-4	Assurance Agreement	Form RD 400-4 - Assurance Agreement.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	0	0
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.