The AD-1047 Certification Regarding Debarment, Suspension, and Other Responsibility Matters is required for all entities entering primary covered transactions with the USDA. By signing this form, the participant certifies they are in good standing with federal agencies and not currently subject to debarment, suspension, or exclusion from federal programs.
The form requires affirmations on three key compliance points. First, the applicant must not be under active debarment or suspension. Second, there must be no criminal convictions or charges related to fraud within the past three years. Third, no previous federal transaction may have been terminated for cause or default. These requirements come from Executive Order 12549 and 2 C.F.R. § 180.335. All participants at every tier of a covered transaction must meet these standards.
Providing false certification carries serious federal consequences, including termination of the covered transaction and potential criminal liability under 18 U.S.C. § 1001. Keep a signed copy of your completed AD-1047 for your records. Related USDA compliance documents include the Certification Regarding Debarment Form for lower-tier transactions and the USDA Form RD 400-6 for equal opportunity requirements.
| Question | Answer |
|---|---|
| Form Name | Ad 1047 Certification Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | ad 1047 certification debarment, ad 1047, 1047 form pdf, 1047 form |