Information Collection

Rural Energy Savings Program (RESP)

IC 221266 under ICR 201604-0572-004 · OMB 0572-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0151 can be found here:

Documents and Forms

Document Name Document Type
Form SF 100 Rural Energy Savings Program (RESP) Form
RUS Form 266 Compliance Assurance RUS266.PDF forms.sc.egov.usda.gov/efcommon/eFileServices/eForms/RUS266.PDF Form
SF 100 EEO-1 Employer Information Report eeo1-2.pdf www.eeoc.gov/employers/eeo1survey/index.cfm Form
AD-1047 Certification Regarding Debarment, Suspension, and other AD-1047 (Dec '15).pdf www.ocio.usda.gov/sites/default/files/docs/2012/AD-1047 %28Dec %2715%29.pdf Form and Instruction
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi AD-1048 (Dec '15).pdf www.ocio.usda.gov/sites/default/files/docs/2012/AD-1048 %28Dec %2715%29.pdf Form and Instruction
AD-1049 Certificate Regarding Drug-Free Workplace Requirements AD-1049 (Dec '15).pdf www.ocio.usda.gov/sites/default/files/docs/2012/AD-1049 %28Dec %2715%29.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rural Energy Savings Program (RESP)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SF 100	EEO-1 Employer Information Report	eeo1-2.pdf	https://www.eeoc.gov/employers/eeo1survey/index.cfm	Yes	Yes	Fillable Fileable
Form and Instruction	AD-1047	Certification Regarding Debarment, Suspension, and other Responsibility Matters (Primary Covered Transactions)	AD-1047 (Dec '15).pdf	http://www.ocio.usda.gov/sites/default/files/docs/2012/AD-1047 %28Dec %2715%29.pdf	Yes	No	Fillable Printable
Form and Instruction	AD-1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion (Lower Tier Covered Transactions)	AD-1048 (Dec '15).pdf	http://www.ocio.usda.gov/sites/default/files/docs/2012/AD-1048 %28Dec %2715%29.pdf	Yes	No	Fillable Printable
Form and Instruction	AD-1049	Certificate Regarding Drug-Free Workplace Requirements	AD-1049 (Dec '15).pdf	http://www.ocio.usda.gov/sites/default/files/docs/2012/AD-1049 %28Dec %2715%29.pdf	Yes	No	Fillable Printable
Form	RUS Form 266	Compliance Assurance	RUS266.PDF	http://forms.sc.egov.usda.gov/efcommon/eFileServices/eForms/RUS266.PDF	Yes	No	Fillable Printable

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	212	212
Annual IC Time Burden (Hours)	1,354	1,354
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.