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Community Facilities Technical Assistance and Training Grant Program

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OMB: 0575-0198

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USDA - RHS
Title of Information Document




OMB No.









0575-AD02
SUMMARY OF INFORMATION COLLECTION
7 CFR 3570 Technical Assistance Programs




Date Prepared










Dec-15
INSTRUCTIONS:

> (f) TOTAL
(h) 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)

Reporting Requirements - Non Forms








3570.265(c)(6) Documentation of assistance provided to Rural Development employees Written 70 1 70 0.25 17.50













3570.265(c)(9) Indirect Cost Agreement Written 70 1 70 1.00 70.00













3570.265(c)(10) Statement of Compliance , Title VI of Civil Rights Act of 1964 Written 70 1 70 0.50 35.00













3570.265(d)(1)(i) Evidence of Legal Existence and Authority Written 70 1 70 0.25 17.50













3570.265(d)(1)(ii) Evidence of Tax Exempt Status Written 70 1 70 0.25 17.50













3570.265(d)(2) Narrative - Project Proposal Written 70 1 70 1.00 70.00










3570.265(d)(3) Latest Financial Information Written 70 1 70 1.00 70.00













3570.265(d)(4) Documentation of cash matching funds Written 70 1 70 0.50 35.00













3570.265(d)(5) Scope of Work/Work Plan Written 70 1 70 2.00 140.00













3570.265(d)(7) Budget justification Written 70 1 70 5.00 350.00













3570.265(d)(8) Evidence of Financial Management System Written 70 1 70 0.25 17.50













3570.265(d)(9) Documentation on each of the priority ranking criteria Written 70 1 70 10.00 700.00



Subtotal


840
1,540.00














Awardees








1775.13 Grant Agreement RHS Bulletin 3570-1 35 1 35 2.00 70.00













1775.2 Project Performance Report Written 35 4 35 12.00 420.00













1775.21 Audit Written 35 1 35 3.00 105.00













1775.21 Financial Statements Written 35 1 35 1.00 35.00



Subtotal


140
630.00



Reporting Requirements - Forms








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













3570.265(c)(5) Certification Regarding Debarment AD-1048 (0505-0027) 70 1 70 0.25 17.50













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













3570.265(c)(7) Equal Opportunity Agreement RD 400-1 (0575-0018) 35 1 35 0.17 5.95













3570.265(c)(8) Assurance Agreement RD 400-4 (0575-0018) 35 1 35 0.25 8.75



Subtotal


280
67.20

Grand Total


1,260
2,237.20











Common Forms Approved Under Other Packages - Burden Reported as RCF

3570.265(c)(1) Application for Federal Assistance (Non-construction Programs) SF-424 (4040-0004) 35 1 35 0.75 26.00













3570.265(c)(2) Budget Information--Non-Construction Programs SF-424A (4040-0006) 35 1 35 3.00 105.00










3570.265(c)(2) Assurances--Non-construction Programs SF-424B (4040-0007) 35 1 35 0.25 8.75













3570.268(a) Request for Advance or Reimbursement SF-270 (4040-0012) 35 12 420 1.00 420.00













3570.265(c)(11) Disclosure of Lobbying Activities SF LLL (4040-0013) 35 1 35 0.25 8.75













3570.270(a) Federal Financial Report SF-425 (4040-0014) 35 4 140 1.50 210.00






































































































































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