Information Collection

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

IC 210082 under ICR 201610-0572-002 · OMB 0572-0149.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0149 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD-1048 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form
Form 395 RUS Contract Form 395 New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form
Form 392a RUS Form 395a - CERTIFICATE OF COMPLETION New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form
Form 395b RUS Form 395b - Certificate of Completion New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form
Form 395c RUS Form 395c - Certificate of Seller New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form
Form 395d RUS Form 395d - Results Of Equiptment Tests New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Form
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi AD-1048 (Dec '15).pdf www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Form
395 RUS Contract Form 395 RUSContractForm395FINAL10-24-16ROCIS.docx www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Form
392a RUS Form 395a - CERTIFICATE OF COMPLETION Form 395a FINAL.docx	Form
395b RUS Form 395b - Certificate of Completion Form 395b FINAL.docx	Form
395c RUS Form 395c - Certificate of Seller Form 395c FINAL.docx	Form
395d RUS Form 395d - Results Of Equiptment Tests Form 395d FINAL.docx	Form

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 1755 7 CFR 1753

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AD-1048	http://www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Yes	No	Printable Only
Form	395	http://www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Yes	No	Printable Only
Form	392a	tp://www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Yes	No	Printable Only
Form	395b	http://www/rurdev.usda.gov/UP_ETPW_Forms.html#telecom	Yes	No	Printable Only
Form	395c	http://www/rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Yes	No	Printable Only
Form	395d	http://www/rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 279

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,407	1,407
Annual IC Time Burden (Hours)	890	890
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.

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