Summary of Information Collection, RUS Form 36

0572-0121 spreadsheet 11-4-14.xlsm

7 CFR 1780, Water and Waste Loan and Grant Program

Summary of Information Collection, RUS Form 36

OMB: 0572-0121

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USDA - RUS
Title of Information Document




OMB No.







Water and Waste Loan and Grant Program





0572-0121




SUMMARY OF INFORMATION COLLECTION
7 CFR 1780




Date Prepared












11/4/2014




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-



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)




NON-FORM BURDEN












1780.1(f) Relationship or association with RUS employees Written 829 1 829 0.25 207




7 CFR 1777-Colonias (0572-0109)
19 1 19 0.25 5







7 CFR 1778-ECWAG (0572-0110)
14 1 14 0.25 4


















1780.7(d) Statement on availability to obtain credit elsewhere Written 829 1 829 1.00 829




7 CFR 1777-Colonias
19 1 19 1.00 19







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.11(a)(2) Notification of service statement Written 211 1 211 2.00 422







7 CFR 1777-Colonias
6 1 6 2.00 12




7 CFR 1778-ECWAG
14 1 14 2.00 28





















1780.14(a)(3) & (b)(2) Liens on real and chattel property Written 167 1 167 1.00 167







7 CFR 1777-Colonias
5 1 5 1.00 5







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.14(b)(2) Financing Statement Written 211 1 211 1.00 211







7 CFR 1777-Colonias
6 1 6 1.00 6







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.19 Public Information Written 707 1 707 2.00 1,414







7 CFR 1777-Colonias
19 1 19 2.00 38







7 CFR 1778-ECWAG
14 1 14 2.00 28







SUBTOTAL


3,112
3,437 0.00 0.00




TOTAL OF ALL PAGES


37,182
105,883 14,000
1,120



TOTAL - Columns "F" and "I" = OMB 83I, 13 b; Columns "H" and "K" = OMB 83I, 13c


51,182
107,003






1780.33(b) Intergovernmental comments Written 707 1 707 1.00 707







7 CFR 1777-Colonias
19 1 19 1.00 19







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.33(c) Preliminary engineering report Written 707 1 707 4.00 2,828







7 CFR 1777-Colonias
19 1 19 4.00 76







7 CFR 1778-ECWAG
14 1 14 4.00 56





















1780.33(e) Supporting documentation Written 707 1 707 6.00 4,242







7 CFR 1777-Colonias
19 1 19 6.00 114







7 CFR 1778-ECWAG
14 1 14 6.00 84





















1780.33(h)(5) Certification Regarding Debarment AD-1047 707 1 707 0.25 177







7 CFR 1777-Colonias
19 1 19 0.25 5







7 CFR 1778-ECWAG
14 1 14 0.25 4





















1780.33(h)(6) Certification Regarding Drug-Free Workplace AD-1049 707 1 707 0.25 177







7 CFR 1777-Colonias
19 1 19 0.25 5







7 CFR 1778-ECWAG
14 1 14 0.25 4





















1780.39(b)(1) and (2) Agreements for professional services Written 707 1 707 4.00 2,828







7 CFR 1777-Colonias
19 1 19 4.00 76







7 CFR 1778-ECWAG
14 1 14 4.00 56





















1780.39(b)(4) Contracts for other services Written 707 1 707 2.00 1,414







7 CFR 1777-Colonias
19 1 19 2.00 38







7 CFR 1778-ECWAG
14 1 14 2.00 28






















SUBTOTAL


5,180
12,950






1780.39(c)(5)(i) Positive programs to encourage connections Written 89 1 89 3.00 267







7 CFR 1777-Colonias
7 1 7 3.00 21







7 CFR 1778-ECWAG
14 1 14 3.00 42





















1780.39(c)(3) User agreement Written 89 1 89 4.00 356







7 CFR 1777-Colonias
7 1 7 4.00 28







7 CFR 1778-ECWAG
14 1 14 4.00 56





















1780.39(d) Interim financing Written 600 1 600 4.00 2,400







7 CFR 1777-Colonias
0 1 0 4.00 0







7 CFR 1778-ECWAG
0 1 0 4.00 0





















1780.39(g)(3) Fidelity or employee dishonesty Bond Written 707 1 707 4.00 2,828







7 CFR 1777-Colonias
19 1 19 4.00 76







7 CFR 1778-ECWAG
14 1 14 4.00 56


















1780.39(g)(4) Property insurance Written 707 1 707 1.00 707







7 CFR 1777-Colonias
19 1 19 1.00 19







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.39(g)(5) General Liability Insurance Written 707 1 707 1.00 707







7 CFR 1777-Colonias
19 1 19 1.00 19







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.39(g)(6) Flood Insurance Written 89 1 89 1.00 89







7 CFR 1777-Colonias
5 1 5 1.00 5







7 CFR 1778-ECWAG
14 1 14 1.00 14






















SUBTOTAL


3,148
7,718






1780.39(g)7) Workman's compensation insurance Written 707 1 707 0.50 354







7 CFR 1777-Colonias
19 1 19 0.50 10







7 CFR 1778-ECWAG
14 1 14 0.50 7





















1780.44(f) Evidence of other funds Written 250 1 250 1.00 250







7 CFR 1777-Colonias
15 1 15 1.00 15







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.44(g)(3) Water rights Written 100 1 100 3.00 300







7 CFR 1777-Colonias
7 1 7 3.00 21







7 CFR 1778-ECWAG
7 1 7 3.00 21





















1780.44(g) Appraisal Report Written 42 1 42 2.00 84







7 CFR 1777-Colonias
3 1 3 1.00 3







7 CFR 1778-ECWAG
0 1 0 1.00 0





















1780.44(g)(1)(ii) User Connections Written 25 1 25 3.00 75







7 CFR 1777-Colonias
2 1 2 1.00 2







7 CFR 1778-ECWAG
0 1 0 1.00 0





















1780.44(g)(4) Lease agreement Written 42 1 42 5.00 210







7 CFR 1777-Colonias
3 1 3 5.00 15







7 CFR 1778-ECWAG
5 1 5 5.00 25





















1780.45(a) Notes, bonds, warrants or other contractural obligations Written 707 1 707 5.00 3,535







7 CFR 1777-Colonias
0 1 0 5.00 0







7 CFR 1778-ECWAG
0 1 0 5.00 0






















SUBTOTAL


1,962
4,940






1780.45(a)(2) Loan Resolution (Public Bodies) RUS Bulletin 1780-27 591 1 591 1.00 591







7 CFR 1777-Colonias
0 1 0 1.00 0







7 CFR 1778-ECWAG
0 1 0 1.00 0





















1780.45(a)(2) Loan Resolution, Security Agreement RUS Bulletin 1780-28 116 1 116 1.00 116







7 CFR 1777-Colonias
0 1 0 1.00 0







7 CFR 1778-ECWAG
0 1 0 1.00 0





















1780.45(c) Grant Agreement RUS Bulletin 1780-12 353 1 353 1.00 353







7 CFR 1777-Colonias
19 1 19 1.00 19







7 CFR 1778-ECWAG
14 1 14 1.00 14







Rural Alaska Village Grants Written 10
10
10





















1780.47(d) Audits Written 3,288 1 3,288 8.00 26,304







7 CFR 1777-Colonias
19 1 19 8.00 152







7 CFR 1778-ECWAG
14 1 14 8.00 112





















1780.47(f) Management report Written 707 4 2,828 8.00 22,624







7 CFR 1777-Colonias
19 4 76 8.00 608







7 CFR 1778-ECWAG
14 4 56 8.00 448





















1780.61 Construction contract forms Written 707 1 707 3.00 2,121







7 CFR 1777-Colonias
19 1 19 3.00 57







7 CFR 1778-ECWAG
14 1 14 3.00 42







SUBTOTAL


8,124
53,571






1780.61(b) Borrower attorney's certification of construction contract Written 707 1 707 15.00 10,605







7 CFR 1777-Colonias
19 1 19 15.00 285







7 CFR 1778-ECWAG
14 1 14 15.00 210





















1780.63 Sewage treatment and bulk water sales contracts Written 89 1 89 3.00 267







7 CFR 1777-Colonias
6 1 6 3.00 18







7 CFR 1778-ECWAG
0 1 0 3.00 0





















1780.74 Contracts awarded prior to application Written 20 1 20 2.00 40







7 CFR 1777-Colonias
1 1 1 2.00 2







7 CFR 1778-ECWAG
0 1 0 2.00 0





















1780.76(b) Monitoring construction Written 707 1 707 5.00 3,535







7 CFR 1777-Colonias
19 1 19 5.00 95







7 CFR 1778-ECWAG
14 1 14 5.00 70





















1780.76(c) Resident Inspector resume Written 707 1 707 2.00 1,414







7 CFR 1777-Colonias
19 1 19 2.00 38







7 CFR 1778-ECWAG
14 1 14 2.00 28





















1780.76(d) Daily inspection report Written 707 18 12,726 0.50 6,363







7 CFR 1777-Colonias
19 18 342 0.50 171







7 CFR 1778-ECWAG
14 18 252 0.50 126





















1780.37(b) Borrower shall maintain accounting records for 3 years




7,000 0.08 560




Contractor required records





7,000 0.08 560



















SUBTOTAL


15,656
23,267 14,000
1,120




FORMS APPROVED UNDER OTHER OMB NUMBERS












1780.44(g)(2) Preliminary Title Opinion RD 1927-9 707 1 707 1.50 1,061







7 CFR 1777-Colonias (0575-0147) 19 1 19 1.50 29







7 CFR 1778-ECWAG
14 1 14 1.50 21





















1780.44(g)(2) Final Title Opinion RD 1927-10 707 1 707 0.34 240







7 CFR 1777-Colonias (0575-0147) 19 1 19 0.34 6







7 CFR 1778-ECWAG
14 1 14 0.34 5





















1780.76(e) Partial Payment Estimate RD 1924-18 707 1 707 0.50 354







7 CFR 1777-Colonias (0575-0042) 19 1 19 0.50 10







7 CFR 1778-ECWAG
14 1 14 0.50 7





















1780.76(h)(2) Contract Change Order RD 1924-7 707 1 707 0.25 177







7 CFR 1777-Colonias (0575-0042) 19 1 19 0.25 5







7 CFR 1778-ECWAG
14 1 14 0.25 4





















1780.33(h)(3) Equal Opportunity Agreement RD 400-1 707 1 707 0.08 57







7 CFR 1777-Colonias (0575-0018) 19 1 19 0.08 2







7 CFR 1778-ECWAG
14 1 14 0.08 1





















1780.33(h)(4) Assurance Agreement RD 400-4 707 1 707 0.25 177







7 CFR 1777-Colonias (0575-0018) 19 1 19 0.25 5







7 CFR 1778-ECWAG
14 1 14 0.25 4





















1780.33(a) Application for Federal Assistance SF 424 829 1 829 1.00 829







7 CFR 1777-Colonias (4040-0004) 22 1 22 1.00 22







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.33(h)(1) Operating Budget RD 442-7 707 1 707 5.00 3,535







7 CFR 1777-Colonias (0575-0015) 19 1 19 5.00 95







7 CFR 1778-ECWAG
14 1 14 5.00 70





















1780.41(a)(3) Balance Sheet or Financial Statement RD 442-3 707 1 707 1.00 707







7 CFR 1777-Colonias (0575-0015) 19 1 19 1.00 19







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.29(b)(1) Agreement for Engineering Services 1942-19 707 1 707 4.00 2,828







7 CFR 1777-Colonias (0575-0015) 19 1 19 4.00 76







7 CFR 1778-ECWAG
14 1 14 4.00 56





















1780.39(f) Resolution of Members or Stockholders RD 1942-8 155 1 167 1.00 167







7 CFR 1777-Colonias (0575-0015) 8 1 13 1.00 13







7 CFR 1778-ECWAG
14 1 20 1.00 20





















1780.41(a)(6) Letter of Intent to Meet Conditions RD 1942-46 707 1 707 1.00 707







7 CFR 1777-Colonias (0575-0015) 19 1 19 1.00 19







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.44(g)(1)(i) Opinion of Counsel Relative to Right-of-Way and Easements RD 442-22 707 1 707 1.00 707







7 CFR 1777-Colonias (0575-0015) 19 1 19 1.00 19







7 CFR 1778-ECWAG
4 1 4 1.00 4





















1780.45(b)(1)(ii) Estimate of Funds Needed for 30-Day Period Commencing ____" RD 440-11 707 1 707 1.00 707







7 CFR 1777-Colonias (0575-0015) 19 1 19 1.00 19







7 CFR 1778-ECWAG
14 1 14 1.00 14





















1780.37(f) Statement of Budget, Income, and Equity RD 442-2 707 1 707 2.50 1,768







7 CFR 1777-Colonias (0575-0015) 19 1 19 2.50 48







7 CFR 1778-ECWAG
14 1 14 2.50 35





















1780.62 Water Purchase Contract RD 442-30 167 1 167 1.00 167







7 CFR 1777-Colonias (0575-0015) 13 1 13 1.00 13







7 CFR 1778-ECWAG
4 1 4 1.00 4





















1780.75 Certification of Contractor's Release RD 1924-9 707 1 707 0.25 177







7 CFR 1777 - Colonias (0575-0042) 19 1 19 0.25 5







7 CFR 1778 -ECWAG
14 1 14 0.25 4





















1780.75 Release by Claimants RD 1924-10 707 1 707 0.50 354







7 CFR 1777 - Colonias (0575-0042) 19 1 19 0.50 10







7 CFR 1778 -ECWAG
14 1 14 0.50 7





















1780.76(f) Inspection Report RD 1924-12 707 3 2,121 0.25 530







7 CFR 1777 - Colonias (0575-0042) 19 3 57 0.25 14







7 CFR 1778 -ECWAG
14 3 42 0.25 11





















1780.45(a) Promissory Note RD 440-22 707 1 707 0.25 177







7 CFR 1777 - Colonias (0575-0015) 19 1 19 0.25 5







7 CFR 1778 -ECWAG
0 1 0 0.25 0




































RUS Form 36 (07-91)

































































































































































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