Forms & Certifications : USDA ARS

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Forms & Certifications

Forms & Certifications

Note: All forms are available in .pdf format (unless otherwise noted). If you require the Acrobat Reader, download it here.

Certifications

Research Support Agreement Certification Packages:

For "Research Support
Agreement" awards
under $100,000

This PDF group contains:

AD-1047 - USDA Debarment & Suspension Certification
AD-1049 - USDA Drug-Free Workplace Certification
AD-3031 - USDA Assurance Regarding Felony Conviction
or Tax Delinquent Status for Corporate Applicants (applicable
if IHE is incorporated)
Conflict of Interest Policy Certification

For "Research Support
Agreement" awards of
$100,000 or more

This PDF group contains:

AD-1047 - USDA Debarment & Suspension Certification
AD-1049 - USDA Drug-Free Workplace Certification
AD-3031 - USDA Assurance Regarding Felony Conviction
or Tax Delinquent Status for Corporate Applicants (applicable
if IHE is incorporated)
Certification Regarding Lobbying
Conflict of Interest Policy Certification

Document	Description
Individual Certifications - for all awards
AD-1047	Certification regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions
AD-1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions
AD-1049	Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I – For Grantees Other Than Individuals
AD-1050	Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative II – For Grantees Who are Individuals
AD-1052	Certification Regarding Drug-Free Workplace State and State Agencies, Federal Fiscal Year
PDF	Certification Regarding Lobbying
SF-LLL	Disclosure of Lobbying Activities
AD-3030	Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants
AD-3031	Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants
REE-26	Organization Information, Representations, Assurances and Certifications
PDF	Conflict of Interest Policy for ARS, ERS & NASS

Forms

Management and Financial Reports -

Form	Description
REE-157 XLS	RSA Management Report Template - for Research Support Agreements (originally ARS-157)
RPPR PDF	Research Performance Progress Report (RPPR) - The RPPR has been mandated by the Federal Office of Management and Budget and coordinated by the National Science Foundation.
REE-269 PDF XLS	Cooperative Agreement Financial Status Report, dated 1/2018. Previous versions are obsolete. - Can be used for Non-Assistance Cooperative Agreements awarded prior to 10/8/2016.
SF-425	Federal Financial Report - applicable for all awards. - When used by the non-Federal entity for Non-Assistance Cooperative Agreements, refer to 7 CFR part 550, 550.123(a) for financial reporting conditions (“a financial report must contain an itemization of actual dollar amounts expended on the project during the reporting period (in line with the approved budget), and cumulative totals expended for each budget category from the start date of the award.”).

Form

Description

REE-157

XLS

RSA Management Report Template - for Research Support Agreements (originally ARS-157)

RPPR

Research Performance Progress Report (RPPR)

- The RPPR has been mandated by the Federal Office of Management and Budget and coordinated by the National Science Foundation.

REE-269

Cooperative Agreement Financial Status Report, dated 1/2018. Previous versions are obsolete.

- Can be used for Non-Assistance Cooperative Agreements awarded prior to 10/8/2016.

SF-425

Federal Financial Report - applicable for all awards.

- When used by the non-Federal entity for Non-Assistance Cooperative Agreements, refer to 7 CFR part 550, 550.123(a) for financial reporting conditions (“a financial report must contain an itemization of actual dollar amounts expended on the project during the reporting period (in line with the approved budget), and cumulative totals expended for each budget category from the start date of the award.”).

Payment/Reimbursement -

Form	Description
SF-270 (OMB No. 4040-0012)	SF-270 Request for Advance or Reimbursement

Form

Description

SF-270

(OMB No. 4040-0012)

SF-270 Request for Advance or Reimbursement

Budget -

Form	Description
OMB No. 4040-0001	Budget for Non-Assistance Cooperative Agreements Research and Related Budget (Total Fed + Non-Fed)
OMB No. 4040-0001	Research and Related Budget (RR Budget) Budget for Grant and Cooperative Agreement s
REE-455	Grant and Cooperative Agreement Budget, dated 11/2018. Previous versions are obsolete.
REE-454	Non-Assistance Cooperative Agreement Budget, dated 11/2018. Previous versions are obsolete.

Tangible Personal Property Report -

Form	Description
SF-428-B	Final Report Form and Instructions (2 pages, 29 kb)
SF-428-C	Disposition Request/Report (2 pages, 27 kb)
SF-428-S	Supplemental Form and Instructions (2 pages, 26 kb)

Other Documents -

Form

Description

AD-475-C

“AND JUSTICE FOR ALL” Poster

The "And Justice For All" Civil Rights poster (AD 475C; Sep 2006) is to be prominently displayed in all offices where there is a ARS, ERS, or NASS presence. The poster should be placed where it may be viewed by employees and customers.

Recipients of federally-assisted programs and non-assistance cooperative agreements, such as land-grant institutions, are required to display this poster in their facilities where it can be viewed by customers.

Research Support Agreement Certification Packages:

Individual Certifications - for all awards