Summary Spread Sheet -Form 36

USDA - RUS		Title of Information Document						OMB No.
		Telecommunication Engineering & Construction							0572-0059
SUMMARY OF INFORMATION COLLECTION		Contracts						Date Prepared
								2011
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 RECORDKEEPING 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)
	Construction Certification Program
1753	Construction Work Plan and Cost Distribution	157	32	1	32	12.00	384.00
Subpart J
1753	Certification of Contractor or Force Account Proposal	158	32	4	128	3.00	384.00
Subpart J	Approval
1753	Summary of Completed Construction	159	32	4	128	6.00	768.00
Subpart J
1753	Certification Borrower Contract Addendum	N/A	32	4	128	1.00	128.00
Subpart J
1753, 1788	Contractor's Bond	168b	Form approved under OMB Docket No. 0572-0107
1753, 1788	Contractor's Bond (less than $1 million)	168c	Form approved under OMB Docket No. 0572-0107
	Architects and Engineers Qualifications	179	4	1	4	2.00	8.00
1753.30	Certificate of Completion - Contract Construction for Building	181	Form approved under OMB Docket No. 0572-0107
	Closeout of Contract Form 257 for Building Construction.
1753	Certificate ("Buy American")	213	Form approved under OMB Docket No. 0572-0107
1753.48(g)	Construction Change Order	216	22	1	22	1.00	22.00
	● When changes or correction are necessary the borrower's
	engineer will prepare a construction change order. A copy
	of each is attached to the construction inventory required
	to close out the contract
IDENTIFICATION OF REPORTING AND RECORDKEEPING REQUIREMENTS						ANNUAL BURDEN
		FORM			REPORTS
		NO(s)	NO. OF	NO. OF	TOTAL	HOURS	TOTAL
SECTION OF		(If "none"	RESPON-	RESPONSES	ANNUAL	PER	HOURS
REGULATIONS	DESCRIPTION	so state)	DENTS	PER	RESPONSES	RESPONSE	(Col. f & g)
				RESPON-	(Col. d & e)
				DENT
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)
	Engineering and Architectural Services
1753	Postloan Engineering Service Contract	217
Subpart B	● Approval of Postloan Engineering Service Contract		45	1	45	7.00	315.00
	● Approval of Postloan Engineering… - Broadband Program		50	1	50	7.00	350.00
	The Postloan Engr. Serv. Contract inclds. using the following forms:
	RUS Form 217a-Project Design, Assistance and Coordination:
	RUS Form 217b-Central Office Equipment Engineering Services;
	RUS Form 217c-Transmission Facilities Engineering Services;
	RUS Form 217d-Building Engineering Services;
	RUS Form 217e-Outside Plant Staking Services;
	RUS Form 217f-Outside Plant Contract Doc. Phase Engr. Servs.
	RUS Form 217g-Outside Plant Construction Phase Engr. Servs.
1753	● Approval of Postloan Engineering Service Contract
Subpart B	Architectural Services Contract	220	Form approved under OMB Docket No. 0572-0118
1753.30,	Waiver and Release of Lien	224	Form approved under OMB Docket No. 0572-0107
39, 49	● Closeout of Contract Form 257 for building construction
	● Closeout of major outside plant contraction by contract
1753.30,	Certificate of Contractor	231	Form approved under OMB Docket No. 0572-0107
39, 49
1753.11,	Construction of Equipment Contract Amendment	238	Form approved under OMB Docket No. 0572-0107
28, 38, 68
	Miscellaneous Engineering Services Forms
	Assignment of Engineering Service Contract	242	3	1	3	0.50	1.50
1753.15,	Engineering Service Contract - Special Services - Telephone	245	4	1	4	0.75	3.00
81	● Engineering services for minor construction may be
	contracted using Form 245 (This contract form does not
	require RUS approval).
1753	Contract to Construct Building	257	Form approved under OMB Docket No. 0572-0107
Subpart D
RE Act	Equal Opportunity Addendum	270
NAFTA	● Form 773 issued for minor construction by contract.		135	1	135	0.25	33.75
	● Form 773, small scale constuction - Broadband Program		150	1	150	0.25	37.50
IDENTIFICATION OF REPORTING AND RECORDKEEPING REQUIREMENTS						ANNUAL BURDEN
		FORM			REPORTS
		NO(s)	NO. OF	NO. OF	TOTAL	HOURS	TOTAL
SECTION OF		(If "none"	RESPON-	RESPONSES	ANNUAL	PER	HOURS
REGULATIONS	DESCRIPTION	so state)	DENTS	PER	RESPONSES	RESPONSE	(Col. f & g)
				RESPON-	(Col. d & e)
				DENT
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)
1753.49	Bidder's Qualifications
	● Submission of bidders' qualifications to the borrower and its	274	9	1	9	1.00	9.00
	engineer.
1753.49	Bidder's Qualifications for Buried Plant Construction
	● Submission of bidders' qualifications to the borrower and its	276
	engineer.		9	1	9	1.00	9.00
175349	Tabulation of Materials Furnished by Borrower
	● Closeout of major outside plans construction by contract.	281
			0	1	0	2.00	0.00
1753.8(b)	Subcontracts (Under Construction or Equipment)
	● Approval of subcontracts (per 1753.8(b))	282	32	1	32	0.75	24.00
1753.16	Certificate of Architect
	● Approval of final statement of cost-architectural services	284	5	1	5	0.50	2.50
	● Approval of final statement… - Broadband Program	284	6	1	6	0.50	3.00
	Bid Bond	307	Form approved under OMB Docket No. 0572-0107
1737	Interim Financing Construction	375
Subpart E	Telecommunications Program		69	1	69	0.25	17.25
	Broadband Program		37	1	37	0.25	9.25
1753.38	Software License Agreement	390
	Telecommunications Program		9	1	9	1.00	9.00
	Broadband Program		10	1	10	1.00	10.00
IDENTIFICATION OF REPORTING AND RECORDKEEPING REQUIREMENTS						ANNUAL BURDEN
		FORM			REPORTS
		NO(s)	NO. OF	NO. OF	TOTAL	HOURS	TOTAL
SECTION OF		(If "none"	RESPON-	RESPONSES	ANNUAL	PER	HOURS
REGULATIONS	DESCRIPTION	so state)	DENTS	PER	RESPONSES	RESPONSE	(Col. f & g)
				RESPON-	(Col. d & e)
				DENT
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)
	Special Equipment Purchases
1753.68	Certificate of Completion, Special Equipment Contract
	(Including Installation)	396	0	1	0	1.50	0.00
	● Closeout of the equipment contract 397.
1753.68	Certificate of Completion, Special Equipment Contract
	(Including Installation)	396a	0	1	0	1.50	0.00
	Special Equipment Contract (Including Installation)
1753.67	● Approval of plans & specification	397	68	1	68	5.00	340.00
1753.68	● Approval of the contract for purchase of initial equipment		45	1	45	1.50	67.50
1753.68	● Approval of the contract for purchase of equipment additions.		9	1	9	1.50	13.50
1753.68	● Approval of contract for the purchase of new		14	1	14	1.50	21.00
	system additions of equipment.
	The burden hours for the following forms are already accounted for under
	RUS Form 397. The Forms are as follows:
	RUS Form 397b – Design Specifications for Trunk Carrier Systems
	RUS Form 397c – Design Specifications for Subscriber Carrier Systems
	RUS Form 397d - Design Specifications for Point-to-Point Microwave Systems
	RUS Form 397g - Specifications for Line Concentrators
	RUS Form 397h – Design Specifications for Digital Lightwave Transmission Systems
	Broad band
	● Approval of plans & specification		118	1	118	6.00	708.00
	● Approval of the contract for purchase of initial equipment		104	1	104	3.00	312.00
	● Approval of contract for the purchase of new		14	1	14	3.00	42.00
	system additions of equipment.
	Special Equipment Contract (Not Including Installation)
1753.67	● Approval of plans & specification	398	26	1	26	1.00	26.00
1753.68	● Approval of the contract for purchase of initial equipment		18	1	18	1.00	18.00
1753.68	● Approval of the contract for purchase of equipment additions.		4	1	4	1.00	4.00
1753.68	● Approval of the contract for the purchase of new		4	1	4	1.00	4.00
	system additions of equipment.
1744.66	Financial Requirements Statement	481	Form approved under OMB Docket No. 0572-0023
	Statement of Engineering Fees - Telecommunications
1753.17	● Estimates	506	45	1	45	6.00	270.00
	● Estimates - Broadband Program		50	1	50	6.00	300.00
1753.17	● Final		45	1	45	6.00	270.00
	● Final - Broadband Program		50	1	50	6.00	300.00
IDENTIFICATION OF REPORTING AND RECORDKEEPING REQUIREMENTS						ANNUAL BURDEN
		FORM			REPORTS
		NO(s)	NO. OF	NO. OF	TOTAL	HOURS	TOTAL
SECTION OF		(If "none"	RESPON-	RESPONSES	ANNUAL	PER	HOURS
REGULATIONS	DESCRIPTION	so state)	DENTS	PER	RESPONSES	RESPONSE	(Col. f & g)
				RESPON-	(Col. d & e)
				DENT
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)
	Major Outside Plant Construction
	Telephone System Construction Contract (Labor and Materials)
1753.47	● Approval of plans and specifications for major outside	515
	plant construction by contract		91	1	91	4.00	364.00
1753.48	● Approval of the outside plant contract		68	1	68	6.00	408.00
	● Approval of plans and specifications for major outside
	plant construction by contract - Broadband Program		100	1	100	8.00	800.00
	● Approval of the outside plant contract - Broadband		75	1	75	4.00	300.00
1753.48	● Owner-Furnished Materials		Information included under RUS Form 787 below.
1753.48	● Approval of negotiated contracts		23	1	23	2.00	46.00
	● Approval of negotiated contracts - Broadband		25	1	25	4.00	100.00
	● Owner-Furnished Materials - Broadband		Information included under RUS Form 787 below.
1753.39	Results of Acceptance Test	517	0	1	0	1.00	0
1753.57	Biweekly Progress Report of Telephone Construction
	and Engineering Service	521	0	1	0	1.00	0
	Central Office Equipment Purchases
	(Including Installation)
1753	Central Office Equipment Contract (Including Installation)
Subpart E
1753.37	● Approval of plans & specs for purchase of COE by bid	525	14	1	14	12.00	168.00
1753.38	● Approval of COE contract		14	1	14	2.00	28.00
1753.37	● Approval of Plans & specs for single source procurement		23	1	23	6.00	138.00
1753.38	● Approval of negotiated proposal		23	1	23	2.00	46.00
1753.38	● Approval of the negotiated contract		23	1	23	1.00	23.00
1753.38	● Approval of supplier's proposal for additions to COE		18	1	18	4.00	72.00
1753.38	● Approval of COE contract for additions		18	1	18	5.00	90.00
1753	Statement of Construction Telephone System - Outside Plant
Subpart E	● Closeout of major outside plant construction by contract	527	0	1	0	1.25	0.00
IDENTIFICATION OF REPORTING AND RECORDKEEPING REQUIREMENTS						ANNUAL BURDEN
		FORM			REPORTS
		NO(s)	NO. OF	NO. OF	TOTAL	HOURS	TOTAL
SECTION OF		(If "none"	RESPON-	RESPONSES	ANNUAL	PER	HOURS
REGULATIONS	DESCRIPTION	so state)	DENTS	PER	RESPONSES	RESPONSE	(Col. f & g)
				RESPON-	(Col. d & e)
				DENT
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)
	Central Office Equipment Purchases
	(Not Including Installation)
1753	Central Office Equipment Contract (Not Including Installation)
Subpart E
1753.37	● Approval of plans & specs for purchase of COE by bid	545	2	1	2	7.00	14.00
1753.38	● Approval of COE contract		2	1	2	3.00	6.00
1753.38	● Approval of plans & specs for single source procurement		5	1	5	7.00	35.00
1753.38	● Approval of COE contract -single source		5	1	5	3.00	15.00
1753.38	● Approval of negotiated proposal		5	1	5	4.00	20.00
1753.37	● Approval of plans & specs - -negotiated proposals		5	1	5	7.00	35.00
1753.38	● Approval of the negotiated contract		5	1	5	3.00	15.00
1753.38	● Approval of supplier's proposal for additions to COE		5	1	5	4.00	20.00
1753.38	● Approval of COE contract for additions		5	1	5	1.00	5.00
1744.66	Certification of Authority	675	Form approved under OMB Docket No. 0572-0074
	Miscellaneous Outside Plant Construction Forms
1753.49	Final Inventory, Telephone Construction Contract
	(Labor and Materials)	724	143	1	143	0.75	107.25
	● Closeout of major outside plant construction by contract
1753.49	Final Inventory, Telephone Construction Contract
	(Labor and Materials) - Detailed	724a	143	1	143	3.00	429.00
	● Tabulation of Assembly Units
1753.49	Final Inventory, Telephone Construction Contract
	(Labor and Materials) - Detailed	724b	0	1	0	0.75	0.00
	● Removals
1753.78	Certificate of Contractor and Indemnity Agreement
	(Line Extensions)	743
	● Upon completion and inspection the borrower obtains
	from the contractor a final invoice and Form 743		0	1	0	0.50	0.00
	● Upon completion and inspection the borrower obtains
	from the contractor a final invoice and Form 743 - Broadband		0	1	0	0.50	0.00
1753.68	Certificate of Contractor and Indemnity Agreement
	● Closeout of the equipment contract 397	744	0	1	0	0.50	0.00
1753.39	Certificate of Completion Central Office Equipment
	(Not Including Installation)	752a	0	1	0	0.50	0.00
IDENTIFICATION OF REPORTING AND RECORDKEEPING REQUIREMENTS						ANNUAL BURDEN
		FORM			REPORTS
		NO(s)	NO. OF	NO. OF	TOTAL	HOURS	TOTAL
SECTION OF		(If "none"	RESPON-	RESPONSES	ANNUAL	PER	HOURS
REGULATIONS	DESCRIPTION	so state)	DENTS	PER	RESPONSES	RESPONSE	(Col. f & g)
				RESPON-	(Col. d & e)
				DENT
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)
	Contract Closeout Certification
1753.18	● Non-form certification	N/A	275	1	275	0.50	137.50
	● Broadband Program	756	238	1	238	0.50	119.00
1753.81-82	Summary of Work Order
	Inspection by GFR	771	10	5	50	0.50	25.00
	Inspection by licensed Engineer or Borrower's Staff Engineer	771a	170	5	850	0.50	425.00
	Broadband Program	771a	200	5	1000	0.50	500.00
1753	Miscellaneous Construction Work and Maintenance
	Service Contract	773
	● Issued for minor construction by contract		135	1	135	2.00	270.00
	● Issued for small-scale construction -Broadband Program		150	1	150	3.00	450.00
1753.48 (f)	Supplement A to Construction Contract RUS Form 515	787
	● Approval for the borrower to furnished materials for outside
	plant construction by contract		18	1	18	0.25	4.50
	● Approval for the borrower to furnished materials for outside
	plant construction by contract - Broadband		10	1	10	0.25	2.50
1753.58	Telephone Force Account Construction - Final Inventory
	Closeout of major outside plant construction by force account	817	0	1	0	2.00	0.00
		817a	0	1	0	2.00	0.00
		817b	0	1	0	2.00	0.00
1753.15	Preloan Engineering Service Contract, Telephone
(a)(2)	System Design	835	0	1	0	0.75	0.00
1753.80 (g)	Minor construction - request to establish a work order fund
	for specific construction project	n/a	3	1	3	2.00	6.00
	Minor construction - request to establish a work order fund
	for specific construction project - Broadband	n/a	4	1	4	2.00	8.00
1753.27	Construction of building - award of contract
		n/a	18	1	18	2.00	36.00
1753.48 (a)	Outside plant major construction - award of construction in
	accordance with procedures	n/a	7	1	7	1.50	10.50
1753.48 (b)	Outside plant major construction - RUS approval of negotiated	n/a	23	1	23	1.50	34.50
	proposals
1753.68 (b)	Special equipment - approval of the
	proposal for initial purchase of equipment	n/a	18	1	18	1.50	27.00
	Core network and access equipment - approval of the
	proposal for initial purchase of equipment - Broadband	n/a	20	1	20	1.50	30.00
IDENTIFICATION OF REPORTING AND RECORDKEEPING REQUIREMENTS						ANNUAL BURDEN
		FORM			REPORTS
		NO(s)	NO. OF	NO. OF	TOTAL	HOURS	TOTAL
SECTION OF		(If "none"	RESPON-	RESPONSES	ANNUAL	PER	HOURS
REGULATIONS	DESCRIPTION	so state)	DENTS	PER	RESPONSES	RESPONSE	(Col. f & g)
				RESPON-	(Col. d & e)
				DENT
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)
1753.36	Core network and access equipment - request for approval
	to negotiate for the purpose of standardization on a	n/a	18	1	18	1.25	22.50
	system basis
	Core network and access equipment - request for approval
	to negotiate for the purpose of standardization on a
	system basis - Broadband	n/a	20	1	20	1.50	30.00
1753.3	During the preconstruction review, obtain approval for any
	construction that does not conform to RUS standards and	n/a	18	1	18	1.50	27.00
	specifications or the approved Loan Design
1753.6	Approval to use other than new or nonstandard materials
	and equipment	n/a	18	1	18	1.50	27.00
	Approval to use other than new or nonstandard materials
	and equipment - Broadband	n/a	20	1	20	1.00	20.00
	TOTALS		513	10	5,382	1.99	10,720.00