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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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	Form and Instruction
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi AD-1048 (Dec '15).pdf	Form and Instruction
AD-1049 Certificate Regarding Drug-Free Workplace Requirements AD-1049 (Dec '15).pdf	Form and Instruction

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.