| USDA - RUS |
|
Title of Information Document |
|
|
|
|
|
OMB No. |
|
|
|
|
|
|
|
|
|
|
|
0572-0112 |
|
| SUMMARY OF INFORMATION COLLECTION |
|
7 CFR 1775 Technical Assistance Programs |
|
|
|
|
|
Date Prepared |
|
|
|
|
|
|
|
|
|
|
|
Mar-10 |
|
| INSTRUCTIONS: |
|
|
|
> |
(f) TOTAL |
|
(h) TOTAL |
|
|
|
| Use this form when a single information collection document involves multiple reporting and |
|
|
|
> |
- |
= (e) Average |
- |
= (g) Average |
- |
= (j) Average |
| recordkeeping requirements. |
|
|
|
> |
(d) TOTAL |
|
(f) TOTAL |
|
(i) TOTAL |
|
| IDENTIFICATION OF REPORTING AND RECORDKEEPPING REQUIREMENTS |
|
|
|
|
|
ANNUAL BURDEN |
|
|
|
|
|
|
FORM |
|
|
REPORTS |
|
|
|
RECORDS |
|
|
|
NO(s) |
NO. OF |
NO. OF |
TOTAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
TOTAL |
| SECTION OF |
|
(If "none" |
RESPON- |
RESPONSES |
ANNUAL |
PER |
HOURS |
RECORD- |
HOURS PER |
RECORD- |
| REGULATIONS |
DESCRIPTION |
so state) |
DENTS |
PER |
RESPONSES |
RESPONSE |
(Col. f & g) |
KEEPERS |
RECORD- |
KEEPING |
|
|
|
|
RESPON- |
(Col. d & e) |
|
|
|
KEEPER |
HOURS |
|
|
|
|
DENT |
|
|
|
|
|
(Col. i & j) |
| (a) |
(b) |
(c) |
(d) |
(e) |
(f) |
(g) |
(h) |
(i) |
(j) |
(k) |
|
Items Cleared With This Package |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(3) |
Narrative |
Written |
142 |
1 |
142 |
2.00 |
284.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(6) |
Budget justification |
Written |
142 |
1 |
142 |
10.00 |
1420.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(1) |
Legal Authority and Responsibility |
Written |
142 |
1 |
142 |
0.25 |
35.50 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(2) |
Evidence of Tax Exempt Status |
Written |
142 |
1 |
142 |
0.25 |
35.50 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(8) |
Scope of Work |
Written |
142 |
1 |
142 |
12.00 |
1704.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.13 |
Grant Agreement |
RUS Bulletin 1775-1 |
45 |
1 |
45 |
2.00 |
90.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.2 |
Project Performance Report |
Written |
45 |
4 |
180 |
12.00 |
2160.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.21 |
Audit |
Written |
6 |
1 |
6 |
3.00 |
18.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Financial Statements |
Written |
45 |
1 |
45 |
1.00 |
45.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10 |
Statement concerning assistance under the National Forest Service-Dependent Rural Communities Economic Diversification Act |
Written |
45 |
1 |
45 |
1.00 |
45.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(3) |
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions |
AD-1047 |
45 |
1 |
45 |
0.25 |
11.25 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(5) |
Certification Regarding Debarment |
AD-1048 |
45 |
1 |
45 |
0.25 |
11.25 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(6) |
Documentation of assistance provided to Rural Development employees |
Written |
142 |
1 |
142 |
0.25 |
35.50 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(9) |
Indirect Cost Agreement |
Written |
142 |
1 |
142 |
1.00 |
142.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(10) |
Statement of Compliance , Title VI of Civil Rights Act of 1964 |
Written |
45 |
1 |
45 |
0.50 |
22.50 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(4) |
Latest Financial Information |
Written |
142 |
1 |
142 |
1.00 |
142.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(7) |
Evidence of Financial Management System |
Written |
142 |
1 |
142 |
0.25 |
35.50 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(4) |
Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees Other Than Individuals |
AD-1049 |
45 |
1 |
45 |
0.25 |
11.25 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.18(a) |
Request for Advance or Reimbursement |
SF 270 |
45 |
12 |
540 |
1.00 |
540.00 |
|
|
|
| |
|
(0348-0004) |
41 |
4 |
164 |
1.00 |
164.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Financial Status Report (Short Form) |
SF 269A |
45 |
4 |
180 |
1.50 |
270.00 |
|
|
|
|
|
(0348-0038) |
|
|
|
|
|
|
|
|
|
Total Hours This Package |
|
142 |
|
2,663 |
|
7222.25 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Items Cleared Under Other Packages |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(1) |
Application for Federal Assistance (Non-construction Programs) |
SF-424 |
168 |
1 |
168 |
0.75 |
126.00 |
|
|
|
|
|
(0348-0043) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(2) |
Budget Information--Non-Construction Programs |
SF-424A |
168 |
1 |
168 |
3.00 |
504.00 |
|
|
|
|
|
(0348-0044) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(2) |
Assurances--Non-construction Programs |
SF-424B |
168 |
1 |
168 |
0.25 |
42.00 |
|
|
|
| |
|
(0348-0040) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(8) |
Equal Opportunity Agreement |
RD 400-1 |
50 |
1 |
50 |
0.17 |
8.50 |
|
|
|
|
|
(0575-0018) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(7) |
Assurance Agreement |
RD 400-4 |
50 |
1 |
50 |
0.25 |
12.50 |
|
|
|
|
|
(0575-0018) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(11) |
Disclosure of Lobbying Activities |
SF LLL |
50 |
1 |
50 |
0.25 |
12.50 |
|
|
|
|
|
(0348-0046) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| RUS Form 36 (07-91) |
|
|
|
|
|
|
|
|
|
|