| USDA - RUS |
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Title of Information Document |
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OMB No. |
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0572-0112 |
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| SUMMARY OF INFORMATION COLLECTION |
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7 CFR 1775 Technical Assistance Programs |
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Date Prepared |
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Sep-14 |
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| INSTRUCTIONS: |
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> |
(f) TOTAL |
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(h) TOTAL |
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| Use this form when a single information collection document involves multiple reporting and |
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> |
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= (e) Average |
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= (g) Average |
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= (j) Average |
| recordkeeping requirements. |
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(d) TOTAL |
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(f) TOTAL |
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(i) TOTAL |
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| IDENTIFICATION OF REPORTING AND RECORDKEEPPING REQUIREMENTS |
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ANNUAL BURDEN |
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FORM |
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REPORTS |
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RECORDS |
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NO(s) |
NO. OF |
NO. OF |
TOTAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
TOTAL |
| SECTION OF |
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(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 |
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RESPON- |
(Col. d & e) |
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KEEPER |
HOURS |
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DENT |
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(Col. i & j) |
| (a) |
(b) |
(c) |
(d) |
(e) |
(f) |
(g) |
(h) |
(i) |
(j) |
(k) |
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Items Cleared With This Package* |
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Initial Application/Application Process |
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Read Regulation/Application Guide |
N/A |
142 |
1 |
142 |
1 |
142 |
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| 1775.10(c)(3) |
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions |
AD-1047 |
45 |
1 |
45 |
0.25 |
11 |
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| 1775.10(c)(5) |
Certification Regarding Debarment |
AD-1048 |
45 |
1 |
45 |
0.25 |
11 |
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| 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 |
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| 1775.10(c)(6) |
Documentation of assistance provided to Rural Development employees |
Written |
142 |
1 |
142 |
0.25 |
36 |
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| 1775.10(c)(9) |
Indirect Cost Agreement |
Written |
142 |
1 |
142 |
1.00 |
142 |
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| 1775.10(c)(10) |
Statement of Compliance , Title VI of Civil Rights Act of 1964 |
Written |
45 |
1 |
45 |
0.50 |
23 |
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| 1775.10 |
Statement concerning assistance under the National Forest Service-Dependent Rural Communities Economic Diversification Act |
Written |
45 |
1 |
45 |
1.00 |
45 |
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| 1775.10(d)(1) |
Legal Authority and Responsibility |
Written |
142 |
1 |
142 |
0.25 |
36 |
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| 1775.10(d)(2) |
Evidence of Tax Exempt Status |
Written |
142 |
1 |
142 |
0.25 |
36 |
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| 1775.10(d)(3) |
Narrative |
Written |
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Initial Submission |
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142 |
1 |
142 |
2.00 |
284 |
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Revised Submission |
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26 |
1 |
26 |
2.00 |
52 |
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| 1775.10(d)(8) |
Scope of Work |
Written |
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Initial Submission |
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142 |
1 |
142 |
12.00 |
1,704 |
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Revised Submission |
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26 |
1 |
26 |
12.00 |
312 |
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| 1775.10(d)(6) |
Budget justification |
Written |
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Initial Submission |
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142 |
1 |
142 |
10.00 |
1,420 |
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Revised Submission |
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26 |
1 |
26 |
10.00 |
260 |
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| 1775.10(d)(4) |
Latest Financial Information |
Written |
142 |
1 |
142 |
1.00 |
142 |
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| 1775.10(d)(7) |
Evidence of Financial Management System |
Written |
142 |
1 |
142 |
0.25 |
36 |
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Post-Application |
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| 1775.13 |
Grant Agreement |
RUS Bulletin 1775-1 |
45 |
1 |
45 |
2.00 |
90 |
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| 1775.2 |
Project Performance Report |
Written |
45 |
4 |
180 |
12.00 |
2,160 |
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| 1775.21 |
Audit |
Written |
6 |
1 |
6 |
3.00 |
18 |
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| 1775.21 |
Financial Statements |
Written |
39 |
1 |
39 |
1.00 |
39 |
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Total Hours This Package |
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142 |
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1,993 |
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7,008 |
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Page __1__ of __2__ |
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Items Cleared Under Other Packages |
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| 1775.10(c)(1) |
Application for Federal Assistance (Non-construction Programs) |
SF-424 |
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Initial Submission |
(4040-0004) |
142 |
1 |
142 |
0.75 |
107 |
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Revised Submission |
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26 |
1 |
26 |
0.75 |
20 |
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| 1775.10(c)(2) |
Budget Information--Non-Construction Programs |
SF-424A |
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Initial Submission |
(4040-0006) |
142 |
1 |
142 |
3.00 |
426 |
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Revised Submission |
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26 |
1 |
26 |
3.00 |
78 |
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| 1775.10(c)(2) |
Assurances--Non-construction Programs |
SF-424B |
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Initial Submission |
(4040-0007) |
142 |
1 |
142 |
0.25 |
36 |
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Revised Submission |
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26 |
1 |
26 |
0.25 |
7 |
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| 1775.10(c)(8) |
Equal Opportunity Agreement |
RD 400-1 |
45 |
1 |
45 |
0.17 |
8 |
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(0575-0018) |
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| 1775.10(c)(7) |
Assurance Agreement |
RD 400-4 |
45 |
1 |
45 |
0.25 |
11 |
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(0575-0018) |
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| 1775.18(a) |
Request for Advance or Reimbursement |
SF-270 |
35 |
12 |
420 |
1.00 |
420 |
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(0348-0004) |
10 |
4 |
40 |
1.00 |
40 |
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| 1775.10(c)(11) |
Disclosure of Lobbying Activities |
SF LLL |
45 |
1 |
45 |
0.25 |
11 |
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(4040-0013) |
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Federal Financial Report |
SF-425 |
45 |
4 |
180 |
1.50 |
270 |
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(0348-0061) |
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| RUS Form 36 (07-91) |
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Page __2__ of __2__ |
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| *Note: Private sector responses = 122. American Indian responses = 20. Total = 142 |
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