Information Collection

Rural Broadband Access Loan & Loan Guarantee Application

IC 1872 under ICR 201103-0572-001 · OMB 0572-0130.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0130 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 532 Rural Broadband Access Loan & Loan Guarantee Application	Form
532 Rural Broadband Access Loan and Loan Guarantee Applicati broadband-application532-2.doc www.rurdev.usda.gov/utp_farmbill.html	Form
Broadband Application Guide 11 16 10.docx Application Guide	IC Document
Schedule C-1 - Legal Opinion.docm Schedule C-1	IC Document
Schedule C-2 - Real Property Schedule.docm Schedule C-2	IC Document
Schedule F-2 - Service Area Demographic Data.docm Schedule F-2	IC Document
Schedule H-1 - Equal Opportunity and Non Discrimination.docm Schedule H-1	IC Document
Schedule H-2 - Certification Regarding Architectural Barriers.docm Schedule H-2	IC Document
Schedule H-3 - Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.docm Schedule H-3	IC Document
Schedule H-4 - Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions.docm Schedule H-4	IC Document
Schedule H-5 - Certification Regarding Lobbying for Contracts, Grants, Loans, and Cooperative Agreements.docm Schedule H-5	IC Document
Schedule H-6 - Certifcate Regarding Flood Hazard Area Precautions.docm Schedule H-6	IC Document
Schedule I - Outstanding Federal Debt.docm Schedule I	IC Document
Schedule J-1 - Investor Proposal.docm Schedule J-1	IC Document
Schedule J-2 - Equity State or Local Govt Bond.docm Schedule J-2	IC Document
Schedule L-1 - Competitive Analysis.docm Schedule L-1	IC Document
Schedule M-2 - Schedule of Debt and Equity Funding.xls Schedule M-2	IC Document
Schedule M-3 - Subscriber Projections and Service Tiers3.xls Schedule M-3	IC Document
Schedule M-4A - Pro Forma 5-Year Financial Forecast.xls Schedule M-4A	IC Document
Schedule M-5 - Additional Cash.pdf Schedule M-5	IC Document
Schedule M-6 - Depreciation Schedule.xls Schedule M-6	IC Document
Schedule N-2 - Service Metrics and Network Management.doc Schedule N-2	IC Document
Schedule N-3 Network Design Certification.doc Schedule N-3	IC Document
Schedule P- Project Capital Investment Workbook.xls Schedule P	IC Document
Schedule R- Licenses and Agreements.xls Schedule R	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Rural Broadband Access Loan & Loan Guarantee Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 1738

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	532	Rural Broadband Access Loan and Loan Guarantee Application	broadband-application532-2.doc	http://www.rurdev.usda.gov/utp_farmbill.html	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	118	93	-15	40
Annual IC Time Burden (Hours)	10,545	545	-3,000	13,000
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Application Guide	Broadband Application Guide 11 16 10.docx	12/17/2010
Schedule C-1	Schedule C-1 - Legal Opinion.docm	12/17/2010
Schedule C-2	Schedule C-2 - Real Property Schedule.docm	12/17/2010
Schedule F-2	Schedule F-2 - Service Area Demographic Data.docm	12/17/2010
Schedule H-1	Schedule H-1 - Equal Opportunity and Non Discrimination.docm	12/17/2010
Schedule H-2	Schedule H-2 - Certification Regarding Architectural Barriers.docm	12/17/2010
Schedule H-3	Schedule H-3 - Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.docm	12/17/2010
Schedule H-4	Schedule H-4 - Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions.docm	12/17/2010
Schedule H-5	Schedule H-5 - Certification Regarding Lobbying for Contracts, Grants, Loans, and Cooperative Agreements.docm	12/17/2010
Schedule H-6	Schedule H-6 - Certifcate Regarding Flood Hazard Area Precautions.docm	12/17/2010
Schedule I	Schedule I - Outstanding Federal Debt.docm	12/17/2010
Schedule J-1	Schedule J-1 - Investor Proposal.docm	12/17/2010
Schedule J-2	Schedule J-2 - Equity State or Local Govt Bond.docm	12/17/2010
Schedule L-1	Schedule L-1 - Competitive Analysis.docm	12/17/2010
Schedule M-2	Schedule M-2 - Schedule of Debt and Equity Funding.xls	12/17/2010
Schedule M-3	Schedule M-3 - Subscriber Projections and Service Tiers3.xls	12/17/2010
Schedule M-4A	Schedule M-4A - Pro Forma 5-Year Financial Forecast.xls	12/17/2010
Schedule M-5	Schedule M-5 - Additional Cash.pdf	12/17/2010
Schedule M-6	Schedule M-6 - Depreciation Schedule.xls	12/17/2010
Schedule N-2	Schedule N-2 - Service Metrics and Network Management.doc	12/17/2010
Schedule N-3	Schedule N-3 Network Design Certification.doc	12/17/2010
Schedule P	Schedule P- Project Capital Investment Workbook.xls	12/17/2010
Schedule R	Schedule R- Licenses and Agreements.xls	12/17/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.