Summary Spreadsheet

USDA - RUS		Title of Information Document						OMB No.
		Rural Alaska Village Grant Program (RAVG) - (Associated with a proposed rule)						0572-NEW
SUMMARY OF INFORMATION COLLECTION								Date Prepared
								2013
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-
NOFA	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)
	Burden Approved under this Package
1784.16(c)
1784.17(c)	Application for Federal Assistance	SF 424	25	1	25	1.00	25
1784.18(b)(1)		(4040-0004)
1784.18(b)(2)	Preliminary Engineering Report	Written	25	1	25	4.00	100
1784.18(b)(5)	Supporting documentation	Written	25	1	25	6.00	150
1784.20(b)(3)	Certification Regarding Debarment	AD-1047	25	1	25	0.25	6
1784.20(b)(4)	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Transaction.”	AD-1048	25	1	25	0.25	6
1784.20(b)(5)	Certification Regarding Drug-Free Workplace	AD-1049	25	1	25	0.25	6
1784.20(b)(8)	Certification for Contracts, Grants and Loans Regarding Lobbying	RD Instr. 1940-Q, Exhibit A-1	25	1	25	0.25	6
1784.20(b)(1)	Equal Opportunity Agreement	RD 400-1	25	1	25	0.08	2
		(0575-0018)
1784.18(b)(5)	Operating Budget	RD 442-7	15	1	15	5.00	75
		(0575-0015)
1784.20(b)(9)	Certification Regarding Prohibited Tying Arrangements	Written	25	1	25	0.25	6
1784.18	Business Plan	Written	15	1	15	4.00	60
1784.18	Land Surveyors Certification and Opinion of Right of Way	Written	15	1	15	1.00	15
1784.27	Grant Agreement	RUS Bulletin 1780-12	15	1	15	1.00	15
1784.28	Audits	Written	15	1	15	8.00	120
1784.28	Management report	Written	15	1	15	8.00	120
1784.20(b)(2)	Assurance Agreement	RD 400-4	25	1	25	0.25	6
		(0575-0018)
1784.21(n)	Agreement for Engineering Services	RD1942-19	15	1	15	4.00	60
		(0575-0015)
1784.20(e)	Letter of Intent to Meet Conditions	RD 1942-46	15	1	15	1.00	15
		(0575-0015)
1784.18	Opinion of Counsel Relative to Right-of-Way & Easements	RD 442-22	15	1	15	1.00	15
		(0575-0015)
1784.35	Daily Inspection Report	Written	15	52	780	0.50	390
1784.18	Statement of Budget, Income and Equity	RD 442-2	15	1	15	2.50	38
1784.20(b)(6)	Civil Rights Compliance Assurance	Written	15	1	15	0.25	4
1784.18	Balance Sheet	RD 442-3	15	1	15	1.00	15
	Burden hours associated with THIS package				1,210		1,256			Page 1
	FORMS APPROVED UNDER OTHER OMB NUMBERS
1784.18	Budget Information - Construction Programs	SF 424C	25	1	25	1.00	25
		(4040-0008)
	Assurances - Construction Programs	SF 424D	15	1	15	0.25	4
		(4040-0009)
1784.20(b)(7)	Disclosure of Lobbying Acitivities	SF LLL	15	1	15	0.25	4
	Total burden associated with OTHER packages				55		33			Page 2
	Total burden hours associated with THIS package				1,210		1,256			Page 1
	COMBINED burden associated with this package				1,265		1,289