| USDA - RUS |
|
Title of Information Document |
|
|
|
|
|
OMB No. |
|
|
|
|
|
|
|
|
|
|
|
|
0572-0138 |
|
|
| SUMMARY OF INFORMATION COLLECTION |
|
7 CFR 1783 Revolving Fund Program |
|
|
|
|
|
Date Prepared |
|
|
|
|
|
|
|
|
|
|
|
|
Oct-10 |
|
|
| INSTRUCTIONS: |
|
|
|
> |
(f) TOTAL |
|
(h) TOTAL |
|
(k) 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 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.12(b) |
Budget Justification |
Written |
5 |
1 |
5 |
10.00 |
50 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.12(b)(5) |
Legal Authority and Responsibility |
Written |
5 |
1 |
5 |
0.25 |
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.12(b)(6) |
Evidence of Tax Exempt Status |
Written |
5 |
1 |
5 |
0.25 |
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.12(b)(9) |
Work Plan Narrative |
Written |
5 |
1 |
5 |
40.00 |
200 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.1 |
Grant Agreement |
Written |
1 |
1 |
1 |
2.00 |
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.36(b)(3)(ii) |
Project Performance Report |
Written |
1 |
4 |
4 |
12.00 |
48 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.36 (b)(3)(I) |
Audit |
Written |
1 |
1 |
1 |
3.00 |
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.36 (b)(3)(Ii) |
Finacial Statements |
Written |
1 |
1 |
1 |
1.00 |
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 3017.335 |
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions |
Written |
1 |
1 |
1 |
0.25 |
0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 3017.335 |
Certification Regarding Debarment |
AD 1048 |
1 |
1 |
1 |
0.25 |
0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| RD 1900-D, 1900.153 |
Documentation of assistance provided to Rural Development employees |
Written |
1 |
1 |
1 |
0.25 |
0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Page __1__ of __3__ |
|
|
| 1783 Exhibit E |
Statement of Compliance, Title VI of Civil Rights Act of 1964 |
Written |
1 |
1 |
1 |
0.50 |
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.12(b)(11) |
Latest Financial Information |
Written |
5 |
1 |
5 |
1.00 |
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783 Exhibit D |
Evidence of Financial Management System |
Written |
1 |
1 |
1 |
0.25 |
0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 3021.23 |
Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees Other Than Individuals |
Written |
1 |
1 |
1 |
0.25 |
0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Hours This Package |
|
5 |
|
38.00 |
|
313.75 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Items Cleared Under Other Packages |
|
|
|
|
|
|
|
|
|
|
| 1783.12(b)(1) |
Application for Federal Assistance (Non-construction Programs) |
SF-424 |
5 |
1 |
5 |
0.75 |
4 |
|
|
|
|
|
|
(4040-0004) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.12(b)(2) |
Budget Information--Non-Construction Programs |
SF-424A |
5 |
1 |
5 |
3.00 |
15 |
|
|
|
|
|
|
(4040-0006) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1783.12(b)(3) |
Assurances--Non-construction Programs |
SF-424B |
5 |
1 |
5 |
0.25 |
1 |
|
|
|
|
| |
|
(4040-0007) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 4.2 Appl. Guide or 7CFR 15.4 |
Equal Opportunity Agreement |
RD 400-1 |
1 |
1 |
1 |
0.17 |
0 |
|
|
|
|
|
|
(0575-0018) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 4.2 Appl. Guide or 7CFR 15.4 |
Assurance Agreement |
RD 400-4 |
1 |
1 |
1 |
0.25 |
0 |
|
|
|
|
|
|
(0575-0018) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 7CFR 3015.84 (a) & 1783.36(a)(2) |
Request for Advance or Reimbursement |
SF 270 |
1 |
12 |
12 |
1.00 |
12 |
|
Page __2__ of __3__ |
|
|
| |
|
(0348-0004) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 7CFR 3016.41(b) & 1783.36(b)(3) |
Federal Financial Report |
SF 425 |
1 |
4 |
4 |
1.50 |
6 |
|
|
|
|
|
|
(0348-0061) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 4.2 Appl. Guide |
Disclosure of Lobbying Activities |
SF LLL |
1 |
1 |
1 |
0.25 |
0 |
|
|
|
|
|
|
(0348-0046) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| RUS Form 36 (07-91) |
|
|
|
|
|
|
|
|
Page __3__ of __3__ |
|
|