OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Telecommunications System Construction Policies and Procedures

IC 1786 under ICR 201403-0572-003 · OMB 0572-0059.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 157
Telecommunications System Construction Policies and Procedures		 Form
157 Construction Work Plan & Cost Distribution
UTP_form_157.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
158 Certification of Contractor or Force Account Proposal Ap
RUS158.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
159 Summary of Completed Construction
RUS159.pdf
http:/www.usda.gov/rus/telecom/publications/forms.htm 		Form
179 Architects and Engineers Qualifications
UTP_form_179.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
216 Construction and Change Order
UTP_form_216.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
217 Postloan Engineering Services Contract-Telecommunication
UTP_form_217.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
242 Assignment of Engineering Service Contract
UTP_form_242.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
245 Engineering Service Contract, Special Services-Telephone
UTP_form_245.pdf
www.usda.gov.rus/telecom/publications/forms.htm 		Form
270 Equal Opportunity Addendum
UTP_form_270.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
274 Bidder's Qualifications
UTP_form_274.pdf
www.usda.gov/rus/teledom/publications/forms.htm 		Form
276 Bidder's Qualifications for Buried Plant Construction
UTP_form_276.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
281 Tabulation of Materials Furnished by Borrower
UTP_form_281.pdf
www.usda.gov/rus/telecom/publicationsforms.htm 		Form
282 Subcontracts-(Under Construction or Equipment Contracts
UTP_form_282.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
284 Certificate of Architect
UTP_form_284.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
375 Interim Financing Construction
UTP_form_375.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
390 Software License Agreement
UTP_form_390.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
396 Certificate of Completion, Special Equipment Contract (i
UTP_form_396.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
396a Certificate of Completion, Special Equipment Contract (N
UTP_form_396a.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
397 Special Equipment Contract (including installation)
UTP_form_397.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
398 Special Equipment Contract (not including installation)
UTP_form_398-01.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
506 Statement of Engineering Fees- Telecommunications
UTP_form_506.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
515 Telephone System Construction Contract(Labor & Materials
UTP_form_515.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
517 Results of Acceptance Tests
UTP_form_517.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
521 BiWeekly Progress Report of Telephone Construciton & Eng
UTP_form_521.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
525 Central Office Equipment Contract (Including installatio
UTP_form_525.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
527 Statement of Construction Telephone System-Outside Plant
UTP_form_527.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
545 Central Office Equipment Contract (not including install
UTP_form_545.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
724 FInal Inventroy, Telephone Construction Contract (Labor&
UTP_form_724.pdf
htpp://www.usda.gov/rus/telecom/publications/forms.htm 		Form
724a Final Inventory, Telephone Construction Cpmtract (Labor
UTP_form_724a.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
724b Final Inventory, Telephone Construction Contract (Labor
UTP_form_724b.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
743 Certificate of Contractor & Indemnity Agreement (Line Ex
UTP_form_743.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
744 Certificate of Contractor and Indemnity Agreement
UTP_form_744.pdf
www.usda.gov/rus.telecom/publications/forms.htm 		Form
752a Certificate of Completion Central Office equipment Contr
UTP_form_752a.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
756 Contract Closeout Certification
UTP_form_756.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
771 Summary of Work orders (Inspection by Agency Field Engin
RUS771.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
787 Supplement A to Construction Contract RUS Form 515
RUS-787.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
817 Final Inventory, Telephone Force Account Construction
UTP_form_817.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
817a Final Inventory, Telephone Force Account Construction
UTP_form_817a.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
817b Final Inventory, Telephone Force Account Construction
UTP_form_817b.pdf
www.usda.gov/rus/telecom/publications.forms.htm 		Form
835 Preloan Engineering Service Contract, Telephone System D
UTP_form_835.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
771a Summary of Work Orders
rus-771a.pdf
www.usda..gov/rus/telecom/publications/forms.htm 		Form
Form 773 Miscellaneous Construction Work and Maintenance Services
RUS773.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
397b Design Specifications for Trunk Carrier Systems
UTP_form_397b.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
397c Design Specification for Subscriber Carrier Systems
UTP_form_397c.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
397d Design Specifications for Point to Point Microwave Radio
UTP_form_397d.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
397g RUS Performance Specification for Line Concentrators
UTP_form_397g.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form
397h Design Specifications for Digital Lightwave Tranmission
UTP_form_397h.pdf
www.usda.gov/rus/telecom/publications/forms.htm 		Form

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 157 Construction Work Plan & Cost Distribution UTP_form_157.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 158 Certification of Contractor or Force Account Proposal Approval RUS158.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Paper Only
Form 159 Summary of Completed Construction RUS159.pdf http:/www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 179 Architects and Engineers Qualifications UTP_form_179.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 216 Construction and Change Order UTP_form_216.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Paper Only
Form 217 Postloan Engineering Services Contract-Telecommunications Systems UTP_form_217.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Paper Only
Form 242 Assignment of Engineering Service Contract UTP_form_242.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 245 Engineering Service Contract, Special Services-Telephone UTP_form_245.pdf http://www.usda.gov.rus/telecom/publications/forms.htm Yes No Printable Only
Form 270 Equal Opportunity Addendum UTP_form_270.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 274 Bidder's Qualifications UTP_form_274.pdf http://www.usda.gov/rus/teledom/publications/forms.htm Yes No Printable Only
Form 276 Bidder's Qualifications for Buried Plant Construction UTP_form_276.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 281 Tabulation of Materials Furnished by Borrower UTP_form_281.pdf http://www.usda.gov/rus/telecom/publicationsforms.htm Yes No Printable Only
Form 282 Subcontracts-(Under Construction or Equipment Contracts UTP_form_282.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 284 Certificate of Architect UTP_form_284.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 375 Interim Financing Construction UTP_form_375.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 771 Summary of Work orders (Inspection by Agency Field Engineer) RUS771.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Paper Only
Form 787 Supplement A to Construction Contract RUS Form 515 RUS-787.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 817 Final Inventory, Telephone Force Account Construction UTP_form_817.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 817a Final Inventory, Telephone Force Account Construction UTP_form_817a.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 817b Final Inventory, Telephone Force Account Construction UTP_form_817b.pdf http://www.usda.gov/rus/telecom/publications.forms.htm Yes No Printable Only
Form 835 Preloan Engineering Service Contract, Telephone System Design UTP_form_835.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 390 Software License Agreement UTP_form_390.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 396 Certificate of Completion, Special Equipment Contract (including installation) UTP_form_396.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 396a Certificate of Completion, Special Equipment Contract (Not including installation) UTP_form_396a.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 397 Special Equipment Contract (including installation) UTP_form_397.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Paper Only
Form 398 Special Equipment Contract (not including installation) UTP_form_398-01.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 506 Statement of Engineering Fees- Telecommunications UTP_form_506.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 515 Telephone System Construction Contract(Labor & Materials) UTP_form_515.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 517 Results of Acceptance Tests UTP_form_517.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 521 BiWeekly Progress Report of Telephone Construciton & Engineering Services UTP_form_521.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 525 Central Office Equipment Contract (Including installation) UTP_form_525.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 527 Statement of Construction Telephone System-Outside Plant UTP_form_527.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 545 Central Office Equipment Contract (not including installation) UTP_form_545.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 724 FInal Inventroy, Telephone Construction Contract (Labor& Materials) UTP_form_724.pdf htpp://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 724a Final Inventory, Telephone Construction Cpmtract (Labor & Material) UTP_form_724a.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 724b Final Inventory, Telephone Construction Contract (Labor & Material) UTP_form_724b.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 743 Certificate of Contractor & Indemnity Agreement (Line Extensions) UTP_form_743.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 752a Certificate of Completion Central Office equipment Contract (not including installation) UTP_form_752a.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 756 Contract Closeout Certification UTP_form_756.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 744 Certificate of Contractor and Indemnity Agreement UTP_form_744.pdf http://www.usda.gov/rus.telecom/publications/forms.htm Yes No Printable Only
Form 771a Summary of Work Orders rus-771a.pdf http://www.usda..gov/rus/telecom/publications/forms.htm Yes No Fillable Printable
Form Form 773 Miscellaneous Construction Work and Maintenance Services Contract RUS773.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Fillable Printable
Form 397b Design Specifications for Trunk Carrier Systems UTP_form_397b.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 397c Design Specification for Subscriber Carrier Systems UTP_form_397c.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 397d Design Specifications for Point to Point Microwave Radio Systems UTP_form_397d.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 397g RUS Performance Specification for Line Concentrators UTP_form_397g.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only
Form 397h Design Specifications for Digital Lightwave Tranmission Systems UTP_form_397h.pdf http://www.usda.gov/rus/telecom/publications/forms.htm Yes No Printable Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,382 0 0 0 0 5,382
Annual IC Time Burden (Hours) 10,720 0 0 0 0 10,720
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.