| USDA - RUS |
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Title of Information Document |
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OMB No. |
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0572-0138 |
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| SUMMARY OF INFORMATION COLLECTION |
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7 CFR 1783 (RFP) Revolving Fund Program |
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Date Prepared |
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8/26/2016 (Rev. 1/9/2017) |
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| INSTRUCTIONS: |
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> |
(f) TOTAL |
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(h) TOTAL |
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(k) 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 |
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| 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 |
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| SECTION OF |
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(If "none" |
RESPON- |
RESPONSES |
ANNUAL |
PER |
HOURS |
RECORD- |
HOURS PER |
RECORD- |
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| 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) |
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| (a) |
(b) |
(c) |
(d) |
(e) |
(f) |
(g) |
(h) |
(i) |
(j) |
(k) |
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Items Cleared With This Package |
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| 1783.12(b) |
Budget Justification |
Written |
4 |
1 |
4 |
10.00 |
40.00 |
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| 1783.12(b)(5) |
Legal Authority and Responsibility |
Written |
4 |
1 |
4 |
0.25 |
1.00 |
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| 1783.12(b)(6) |
Evidence of Tax Exempt Status |
Written |
4 |
1 |
4 |
0.25 |
1.00 |
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| 1783.12(b)(9) |
Work Plan Narrative |
Written |
4 |
1 |
4 |
40.00 |
160 |
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| 1783.1 |
Grant Agreement |
Written |
4 |
1 |
4 |
2.00 |
8 |
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| 1783.36(b)(3)(ii) |
Project Performance Report |
Written |
3 |
4 |
12 |
12.00 |
144 |
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| 1783.36 (b)(3)(I) |
Audit |
Written |
3 |
1 |
3 |
3.00 |
9 |
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| 1783.36 (b)(3)(Ii) |
Financial Statements |
Written |
3 |
1 |
3 |
1.00 |
3 |
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| 3017.335 |
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions |
AD 1047 |
3 |
1 |
3 |
0.25 |
0.75 |
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| 3017.335 |
Certification Regarding Debarment |
AD 1048 |
3 |
1 |
3 |
0.25 |
0.75 |
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| RD 1900-D, 1900.153 |
Documentation of assistance provided to Rural Development employees |
Written |
3 |
1 |
3 |
0.25 |
0.75 |
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Page __1__ of __3__ |
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| 1783 Exhibit E |
Statement of Compliance, Title VI of Civil Rights Act of 1964 |
Written |
3 |
1 |
3 |
0.50 |
1.00 |
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| 1783.12(b)(11) |
Balance Sheets and Financial Statements (Latest Financial Information) |
Written |
4 |
1 |
4 |
1.00 |
4.00 |
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| 1783 Exhibit D |
Evidence of Financial Management System |
Written |
3 |
1 |
3 |
0.25 |
0.75 |
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| 3021.23 |
Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees Other Than Individuals |
AD 1049 |
3 |
1 |
3 |
0.25 |
0.75 |
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| 4.2 Appl. Guide or 7CFR 15.4 |
Equal Opportunity Agreement |
RD 400-1 |
3 |
1 |
3 |
0.17 |
0.51 |
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(0575-0018) |
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| 4.2 Appl. Guide or 7CFR 15.4 |
Assurance Agreement |
RD 400-4 |
3 |
1 |
3 |
0.25 |
0.75 |
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(0575-0018) |
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Total Hours This Package |
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4 |
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66.00 |
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376.01 |
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Page __2__ of __3__ |
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Items Cleared Under Other Packages |
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| 1783.12(b)(1) |
Common Form - Burden reported as RCF Application for Federal Assistance (Non-construction Programs) |
SF-424 |
4 |
1 |
4 |
1.00 |
4 |
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(4040-0004) |
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| 1783.12(b)(2) |
Budget Information--Non-Construction Programs |
SF-424A |
4 |
1 |
4 |
1.00 |
4 |
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(4040-0006) |
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| 1783.12(b)(3) |
Assurances--Non-construction Programs |
SF-424B |
4 |
1 |
4 |
0.50 |
2 |
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(4040-0007) |
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| 7CFR 3015.84 (a) & 1783.36(a)(2) |
Request for Advance or Reimbursement |
SF 270 |
3 |
12 |
36 |
1.00 |
36 |
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(4040-0012) |
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| 7CFR 3016.41(b) & 1783.36(b)(3) |
Federal Financial Report |
SF 425 |
3 |
4 |
12 |
1.00 |
12 |
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(4040-0014) |
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| 4.2 Appl. Guide |
Disclosure of Lobbying Activities |
SF LLL |
3 |
1 |
3 |
1.00 |
3 |
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(4040-0013) |
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Total Hours - OTHER Packages |
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4 |
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63.00 |
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61.00 |
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| RUS Form 36 (07-91) |
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Page __3__ of __3__ |
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