| Section of Regulation |
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Reports |
Total Annual |
Est. No. of |
Est. Total |
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Total |
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Form No. |
Est. No. of |
Filed |
Responses |
Man hours |
Man-hours |
Wage |
Cost |
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Title |
(if Any) |
Respondents |
Annually |
(D) x (E) |
Per Response |
(F) x (G) |
Class |
(H) x (I) |
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| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
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REPORTING REQUIREMENTS - NO FORMS |
| 4284.102 (c) |
Identity of Interest Statement |
written |
700 |
1 |
700 |
0.25 |
175 |
$25 |
$4,375 |
| 4284.106 (d) / 4284.126 (e) |
Applicant Eligibility Certification |
written |
700 |
1 |
700 |
0.5 |
350 |
$25 |
$8,750 |
| 4284.116/ 4284.144 (g) |
Small Business Eligibility Certification |
written |
400 |
1 |
400 |
0.5 |
200 |
$25 |
$5,000 |
| 4284.126 (b) |
Intergovernmental Comments |
written |
400 |
1 |
400 |
5 |
2000 |
$25 |
$50,000 |
| 4284.126 (c) |
Evidence of legal existence |
written |
700 |
1 |
700 |
8 |
5600 |
$100 |
$560,000 |
| 4284.126 (f) |
Financial Statements |
written |
700 |
1 |
700 |
4 |
2800 |
$50 |
$140,000 |
| 4284.126 (g) |
Preliminary Engineering Report (construction only) |
written |
150 |
1 |
150 |
6 |
900 |
$80 |
$72,000 |
| 4284.126 (h) |
Scope of Work |
written |
550 |
1 |
550 |
30 |
16500 |
$25 |
$412,500 |
| 4284.128 |
Documented information for scoring criteria |
written |
700 |
1 |
700 |
4 |
2800 |
$25 |
$70,000 |
| 4284.135 |
Civil Rights data collection |
written |
400 |
1 |
400 |
12 |
4800 |
$25 |
$120,000 |
| 4284.139 (g) |
Evidence of nonprofit enity or other tax-exempt organization |
written |
10 |
1 |
10 |
1 |
10 |
$25 |
$250 |
| 4284.143 (b) |
Official plans and specs (construction only) |
written |
75 |
1 |
75 |
2 |
150 |
$80 |
$12,000 |
| 4284.143 (d) |
Appraisal |
written |
75 |
1 |
75 |
4 |
300 |
$50 |
$15,000 |
| 4284.143 (f) |
Evidence of supplemental funding |
written |
400 |
1 |
400 |
8 |
3200 |
$25 |
$80,000 |
| 4284.143 (g) / 4284.143 (i) |
Evidence of commitment (small business/adult student/jobs) |
written |
400 |
1 |
400 |
8 |
3200 |
$25 |
$80,000 |
| 4284.143 (j) |
Evidence of project plan |
written |
300 |
1 |
300 |
1 |
300 |
$25 |
$7,500 |
| 4284.144 (I) |
Revolving loan fund work plan |
written |
150 |
1 |
150 |
40 |
6000 |
$25 |
$150,000 |
| 4284.167 (a) |
Project Performance Report |
written |
300 |
1 |
300 |
4 |
1200 |
$25 |
$30,000 |
| 4284.167 (c ) |
Audit Report |
written |
50 |
1 |
50 |
8 |
400 |
$50 |
$20,000 |
| 4284.184 (c ) |
Control Agreement |
written |
100 |
1 |
100 |
1.5 |
150 |
$25 |
$3,750 |
| 4284.184 (h)(1) & (2) |
Narrative on ultimate recipient loan |
written |
100 |
1 |
100 |
8 |
800 |
$25 |
$20,000 |
| REPORTING REQUIREMENTS - FORMS |
| 4284.153 |
RBEG Grant Agreement |
RD 4284-1 |
400 |
1 |
400 |
0.5 |
200 |
$25 |
$5,000 |
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| RECORD KEEPING REQUIREMENTS |
| 4284.173 |
Record Retention |
records |
400 |
on occasion |
400 |
3 |
1,200 |
$25 |
$30,000 |
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Totals |
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8,160 |
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53,235 |
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$1,896,125 |
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REPORTING REQUIREMENTS - FORMS APPROVED UNDER OTHER OMB NUMBERS |
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| 4284.125 |
Application for Federal Assistance (Preapplication) |
SF 424 (4040-0004) |
700 |
1 |
700 |
1 |
700 |
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| 4284.126 (a) |
Application for Federal Assistance (Application) |
SF 424 (4040-0004) |
400 |
1 |
400 |
1 |
400 |
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| 4284.126 (a) |
Budget Information - Non-construction Programs |
SF 424A (4040-0006) |
325 |
1 |
325 |
3 |
975 |
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| 4284.126 (a) |
Assurances - Non-construction Programs |
SF 424B (4040-0040) |
325 |
1 |
325 |
0.25 |
81 |
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| 4284.126 (a) |
Budget Information - Construction Programs |
SF 424C (4040-0008) |
75 |
1 |
75 |
3 |
225 |
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| 4284.126 (a) |
Assurances - Construction Programs |
SF 424D (4040-0009) |
75 |
1 |
75 |
0.25 |
19 |
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| 4284.126 (d) / 4284.184 (h)(5) |
Request for Environmental Information |
RD 1940-20 (0575-0094) |
600 |
1 |
600 |
6 |
3600 |
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| 4284.143 (p) |
Disclosure of Lobbying Activities (over $100,000) |
SF LLL (0348-0046) |
10 |
1 |
10 |
0.16 |
2 |
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| 4284.143 (k) |
Equal Opportunity Agreement |
RD 400-1 (0575-0018) |
75 |
1 |
75 |
0.16 |
12 |
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| 4284.143 (l) |
Assurance Agreement |
RD 400-4 (0575-0018) |
400 |
1 |
400 |
0.25 |
100 |
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| 4284.152 |
Letter of Intent |
RD 1942-46 (0575-0015) |
400 |
1 |
400 |
1 |
400 |
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| 4284.158 (a) |
Request for Advance or Reimbursement |
SF 270 (0348-0006) |
325 |
6 |
1950 |
1 |
1950 |
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| 4284.158 (a) |
Outlay Report and Request for Reimbursement for Const. Projects |
SF 271 (0348-0004) |
75 |
6 |
450 |
1 |
450 |
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| 4284.167 (b)(1) |
Financial Status Reports |
SF 269 (0348-0039) or SF 269 A (0348-0038) |
400 |
4 |
1600 |
1 |
1600 |
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| 4284.167 (b)(2) |
Reporting of IRP/RDLF Lending Activity |
RD 1951-4 (0570-0015) |
75 |
4 |
300 |
4 |
1200 |
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| REPORTING REQUIREMENTS |
| 4284.143 (m) |
Cert. Regarding Drug-Free Workplace Req. (Grants) Alt. I - For Grantees Other Than Individuals |
AD -1049 |
400 |
1 |
400 |
0.25 |
100 |
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| 4284.143 (n) |
Certification Regarding Debarment, Suspension & Other Resp. Matters-Primary Covered Trans. |
AD-1047 |
400 |
1 |
400 |
0.25 |
100 |
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| 4284.143 (o) |
Cert. For Contracts, Grants and Loans (over $100,000) |
RD Ins. 1940-Q, Exhibit A-1 |
100 |
1 |
100 |
0.16 |
16 |
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| 4284.184 (h) (6) |
Certification Regarding Debarment, Suspension, Ineligibility & Vol. Excl. -Lower Tiered Covered Trans. |
AD-1048 |
200 |
1 |
200 |
0.25 |
50 |
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