New Equipment Contract (Form 395) for Telecommunications and Broadband Borrowers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 395d RUS Form 395d - Results Of Equiptment Tests	Form	Modified	Repair queued
Form 395c RUS Form 395c - Certificate of Seller	Form	Modified	Available
Form 395b RUS Form 395b - Certificate of Completion	Form	Modified	Repair queued
Form 392a RUS Form 395a - CERTIFICATE OF COMPLETION	Form	Modified	Available
Form 395 RUS Contract Form 395	Form	Modified	Available
Form AD-1048 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	Form	Modified	Repair queued
FINAL-Form 395 SS(Rev. 4 ROCIS 10-18-2016.docx	Supporting Statement A	Uploaded 2016-10-24	Available
SFLLL_1_2_P-V1.2.pdf	Supplementary Document	Uploaded 2016-10-24	Repair queued
Form 213 instructions.mht	Supplementary Document	Uploaded 2014-01-16	Available
Form 238 instructions.mht	Supplementary Document	Uploaded 2014-01-16	Repair queued
Form_238.pdf	Supplementary Document	Uploaded 2014-01-16	Repair queued
2013-Spreadsheet -01-03-14 mpd-submitted req. data.xls	Supplementary Document	Uploaded 2014-01-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210082	New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form	Modified	RUS Form 395d - Results Of Equiptment Tests
210082	New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form	Modified	RUS Form 395c - Certificate of Seller
210082	New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form	Modified	RUS Form 395b - Certificate of Completion
210082	New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form	Modified	RUS Form 395a - CERTIFICATE OF COMPLETION
210082	New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form	Modified	RUS Contract Form 395
210082	New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form	Modified	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion

ICR Details

OMB Control No: 0572-0149	ICR Reference No: 201610-0572-002
Status: Historical Active	Previous ICR Reference No: 201401-0572-003
Agency/Subagency: USDA/RUS	Agency Tracking No:
Title: New Equipment Contract (Form 395) for Telecommunications and Broadband Borrowers
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/01/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/24/2016
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2019	36 Months From Approved
Responses	1,407	0	0
Time Burden (Hours)	890	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In an effort to improve customer service to the RUS rural borrowers, the Agency has proposed to revise and streamline its current contracts. RUS has and will continue to work with industry groups to obtain their input as to what types of changes the borrowers may want to see made to the contracts.

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Authorizing Statute(s): US Code: 7 USC 901 et seq.,as amended Name of Law: RE Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0572-AC29	Final or interim final rulemaking	81 FR 71579	10/18/2016

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Federal Register Notices & Comments
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 71579	10/18/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	395c, 392a, AD-1048, 395, 395b, 395d	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion ,   RUS Contract Form 395 ,   RUS Form 395a - CERTIFICATE OF COMPLETION ,   RUS Form 395b - Certificate of Completion ,   RUS Form 395c - Certificate of Seller ,   RUS Form 395d - Results Of Equiptment Tests

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,407	0	0	1,407	0	0
Annual Time Burden (Hours)	890	0	0	890	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection of information.

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Annual Cost to Federal Government: $20,516

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/24/2016

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