| USDA - RHS |
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Title of Information Document |
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OMB No. |
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0575-AD02 |
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| SUMMARY OF INFORMATION COLLECTION |
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7 CFR 3570 Technical Assistance Programs |
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Date Prepared |
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Dec-15 |
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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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Reporting Requirements - Non Forms |
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| 3570.265(c)(6) |
Documentation of assistance provided to Rural Development employees |
Written |
70 |
1 |
70 |
0.25 |
17.50 |
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| 3570.265(c)(9) |
Indirect Cost Agreement |
Written |
70 |
1 |
70 |
1.00 |
70.00 |
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| 3570.265(c)(10) |
Statement of Compliance , Title VI of Civil Rights Act of 1964 |
Written |
70 |
1 |
70 |
0.50 |
35.00 |
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| 3570.265(d)(1)(i) |
Evidence of Legal Existence and Authority |
Written |
70 |
1 |
70 |
0.25 |
17.50 |
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| 3570.265(d)(1)(ii) |
Evidence of Tax Exempt Status |
Written |
70 |
1 |
70 |
0.25 |
17.50 |
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| 3570.265(d)(2) |
Narrative - Project Proposal |
Written |
70 |
1 |
70 |
1.00 |
70.00 |
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| 3570.265(d)(3) |
Latest Financial Information |
Written |
70 |
1 |
70 |
1.00 |
70.00 |
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| 3570.265(d)(4) |
Documentation of cash matching funds |
Written |
70 |
1 |
70 |
0.50 |
35.00 |
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| 3570.265(d)(5) |
Scope of Work/Work Plan |
Written |
70 |
1 |
70 |
2.00 |
140.00 |
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| 3570.265(d)(7) |
Budget justification |
Written |
70 |
1 |
70 |
5.00 |
350.00 |
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| 3570.265(d)(8) |
Evidence of Financial Management System |
Written |
70 |
1 |
70 |
0.25 |
17.50 |
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| 3570.265(d)(9) |
Documentation on each of the priority ranking criteria |
Written |
70 |
1 |
70 |
10.00 |
700.00 |
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Subtotal |
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840 |
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1,540.00 |
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Awardees |
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| 1775.13 |
Grant Agreement |
RHS Bulletin 3570-1 |
35 |
1 |
35 |
2.00 |
70.00 |
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| 1775.2 |
Project Performance Report |
Written |
35 |
4 |
35 |
12.00 |
420.00 |
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| 1775.21 |
Audit |
Written |
35 |
1 |
35 |
3.00 |
105.00 |
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| 1775.21 |
Financial Statements |
Written |
35 |
1 |
35 |
1.00 |
35.00 |
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Subtotal |
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140 |
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630.00 |
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Reporting Requirements - Forms |
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| 3570.265(c)(3) |
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions |
AD-1047 (0505-0027) |
70 |
1 |
70 |
0.25 |
17.50 |
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| 3570.265(c)(5) |
Certification Regarding Debarment |
AD-1048 (0505-0027) |
70 |
1 |
70 |
0.25 |
17.50 |
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| 3570.265(c)(4) |
Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees Other Than Individuals |
AD-1049 (0505-0027) |
70 |
1 |
70 |
0.25 |
17.50 |
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| 3570.265(c)(7) |
Equal Opportunity Agreement |
RD 400-1 (0575-0018) |
35 |
1 |
35 |
0.17 |
5.95 |
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| 3570.265(c)(8) |
Assurance Agreement |
RD 400-4 (0575-0018) |
35 |
1 |
35 |
0.25 |
8.75 |
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Subtotal |
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280 |
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67.20 |
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Grand Total |
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1,260 |
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2,237.20 |
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Common Forms Approved Under Other Packages - Burden Reported as RCF |
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| 3570.265(c)(1) |
Application for Federal Assistance (Non-construction Programs) |
SF-424 (4040-0004) |
35 |
1 |
35 |
0.75 |
26.00 |
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| 3570.265(c)(2) |
Budget Information--Non-Construction Programs |
SF-424A (4040-0006) |
35 |
1 |
35 |
3.00 |
105.00 |
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| 3570.265(c)(2) |
Assurances--Non-construction Programs |
SF-424B (4040-0007) |
35 |
1 |
35 |
0.25 |
8.75 |
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| 3570.268(a) |
Request for Advance or Reimbursement |
SF-270 (4040-0012) |
35 |
12 |
420 |
1.00 |
420.00 |
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| 3570.265(c)(11) |
Disclosure of Lobbying Activities |
SF LLL (4040-0013) |
35 |
1 |
35 |
0.25 |
8.75 |
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| 3570.270(a) |
Federal Financial Report |
SF-425 (4040-0014) |
35 |
4 |
140 |
1.50 |
210.00 |
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