Voluntary Survey on the Equal Treatment Rule

DRAFT Voluntary Survey on the Equal Treatment Rule Form Approval

OMB No.______

I. Please tell us about your non-profit organization:

(1.) Is your organization (please check one): faith-based_____ secular_____

(2.) Organization's annual budget: $___________

(3.) Number of paid staff: full-time________ part-time________

(4.) Year organization was established: __________

II. What program(s) did your organization apply for:

RD-Community Facilities Direct Loans____ RD-Guaranteed Rural Rental Housing Loans______

RD-Community Facilities Guaranteed Loans____ RD-Mutual Self-Help Housing Grants______

RD-Community Facilities Grants____ RD-Rural Housing Preservation Grants____

RD-Rural Community Development Initiatives Grants____ RD-Rural Rental Housing Loans____

RD-Farm Labor Housing Loans____ RD-Technical and Supervisory Assistance Grants (RH)____

RD-Farm Labor Housing Grants____ RD-Distance Learning & Telemedicine Grants____

RD-Rental Assistance Grants____ RD-Rural Business Enterprise Grants____

III. How did you find out about applying for USDA Rural Development Programs?

Public Notice/Advertisement_________ Agency Informational Meeting__________

FBCI Conference (National or Local)___________ Word of Mouth_____________

Other:___________________________________________________________________

IV. When applying for assistance (grant, direct loan, or guaranteed loan) to a Rural Development program, was your organization informed that it would need to make any of the following changes in order to become eligible for assistance:

(1.) Revise the organization's mission or purpose statement? Yes / No

If your answer is yes, please answer the following:

(a.) What was the reason(s) provided?_________________________________________

____________________________________________________________________

(b.) If this change was mandated not by Rural Development but by another governmental entity,

please provide the name of the entity and any legal authority for the change cited by

entity._______________________________________________________________

____________________________________________________________________

(2.) Change the structure or membership of the organization's board of directors? Yes____ No____

If your answer is yes, please answer the following:

(a.) What was the reason(s) provided?__________________________________________________

_____________________________________________________________________________

(b.) If this change was mandated not by Rural Development but by another governmental entity, please

provide the name of the entity and any legal authority for the change cited by the entity.

_____________________________________________________________________________

_____________________________________________________________________________

(3.) Revise any other part of the organization's by-laws? Yes____ No_____

If your answer is yes, please answer the following:

(a.) What was the reason(s) provided?__________________________________________________

_____________________________________________________________________________

(b.) If this change was mandated not by Rural Development but by another governmental entity, please

provide the name of the entity and any legal authority for the change cited by the entity.

(4.) Create a separate 501(c)(3) organization to administer the funds? Yes____ No____

If your answer is yes, please answer the following:

(a.) What was the reason(s) provided?__________________________________________________

_____________________________________________________________________________

(b.) If this change was mandated not by Rural Development but by another governmental entity, please

provide the name of the entity and any legal authority for the change cited by the entity.

_____________________________________________________________________________

_____________________________________________________________________________

(5.) Disallow hiring practices based upon religious affiliation? Yes____ No____

If your answer is yes, please answer the following:

(a.) What was the reason(s) provided?__________________________________________________

_____________________________________________________________________________

(c.) If this change was mandated not by Rural Development but by another governmental entity, please

provide the name of the entity and any legal authority for the change cited by the entity.

(6) Remove religious symbols from the space in which the social services are provided? Yes____ No____

If your answer is yes, please answer the following:

1. What was the reasons(s) provided?____________________________________________________

________________________________________________________________________________

2. If this change was mandated not by Rural Development but by another governmental entity, please

provide the name of the entity and any legal authority for the change cited by the entity.

________________________________________________________________________________

________________________________________________________________________________

V. If you would like USDA Rural Development to follow up with your organization on any of the above issues, please provide your contact information:

Organization Name: _____________________________________________________________________

Mailing Address: _______________________________________________________________________

________________________________________________________________________

Phone Number:___________________________ Fax Number:_________________________________

E-Mail:__________________________________ Website: ____________________________________­_

Contact Name and Title:__________________________________________________________________

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is ________. The time required to complete this information collection is estimated to average 5 minutes per response, including time for reviewing instructions and completing and reviewing the collection of information.