Form 36

0572-0112 Spreadsheet(Form 36).xlsm

Technical Assistance Program - 7 CFR 1775

Form 36

OMB: 0572-0112

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USDA - RUS
Title of Information Document




OMB No.










0572-0112

SUMMARY OF INFORMATION COLLECTION
7 CFR 1775 Technical Assistance Programs




Date Prepared











May-17

INSTRUCTIONS:

> (f) TOTAL
(h) TOTAL


Use this form when a single information collection document involves multiple reporting and


> - = (e) Average - = (g) Average - = (j) Average
recordkeeping requirements.


> (d) TOTAL
(f) TOTAL
(i) TOTAL

IDENTIFICATION OF REPORTING AND RECORDKEEPPING REQUIREMENTS




ANNUAL BURDEN






FORM

REPORTS


RECORDS



NO(s) NO. OF NO. OF TOTAL HOURS TOTAL NO. OF ANNUAL TOTAL
SECTION OF
(If "none" RESPON- RESPONSES ANNUAL PER HOURS RECORD- HOURS PER RECORD-
REGULATIONS DESCRIPTION so state) DENTS PER RESPONSES RESPONSE (Col. f & g) KEEPERS RECORD- KEEPING




RESPON- (Col. d & e)


KEEPER HOURS




DENT




(Col. i & j)
(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k)

Items Cleared With This Package*






















Initial Application/Application Process





















1775.10(c)(6) Documentation of assistance provided to Rural Development employees Written 82 1 82 0.25 21















1775.10(c)(9) Indirect Cost Agreement Written 82 1 82 1.00 82















1775.10(c)(10) Statement of Compliance , Title VI of Civil Rights Act of 1964 Written 82 1 82 0.50 41















1775.10 Statement concerning assistance under the National Forest Service-Dependent Rural Communities Economic Diversification Act Written 82 1 82 1.00 82















1775.10(d)(1) Legal Authority and Responsibility Written 82 1 82 0.25 21















1775.10(d)(2) Evidence of Tax Exempt Status Written 82 1 82 0.25 21















1775.10(d)(3) Narrative Written









Initial Submission
82 1 82 2.00 164




Revised Submission
53 1 53 2.00 106












1775.10(d)(8) Scope of Work Written









Initial Submission
82 1 82 12.00 984




Revised Submission
53 1 53 12.00 636















1775.10(d)(6) Budget justification Written









Initial Submission
82 1 82 10.00 820




Revised Submission
53 1 53 10.00 530















1775.10(d)(4) Latest Financial Information Written 82 1 82 1.00 82















1775.10(d)(7) Evidence of Financial Management System Written 82 1 82 0.25 21
















Post-Application









1775.13 Grant Agreement RUS Guide 1775-1 53 1 53 2.00 106















1775.2 Project Performance Report Written 53 4 212 12.00 2,544















1775.21 Audit Written 12 1 12 3.00 36















1775.21 Financial Statements Written 41 1 41 1.00 41


























Items Cleared Under Other Packages





















1775.10(c)(3) Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions AD-1047 (0505-0027) 45 1 45 0.25 11















1775.10(c)(5) Certification Regarding Debarment AD-1048 (0505-0027) 45 1 45 0.25 11















1775.10(c)(4) Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees Other Than Individuals AD-1049 (0505-0027) 45 1 45 0.25 11
















Total Hours This Package
82
1,514
6,369
PAGE 1














Representations Regarding Felony Conviction and Tax AD-3030 82 1 82 0.25 21




Delinquent Status for Corporate Applicants (0505-0025)





















Assurances Regarding Felony Conviction and Tax Deilnquent AD-3031 41 1 41 0.05 2




Status for Corporate Applicants (0505-0025)
































1775.10(c)(1) Application for Federal Assistance (Non-construction Programs) SF-424






Initial Submission (4040-0004) 82 1 142 0.75 107



Revised Submission
26 1 26 0.75 20















1775.10(c)(2) Budget Information--Non-Construction Programs SF-424A






Initial Submission (4040-0006) 82 1 142 3.00 426




Revised Submission
26 1 26 3.00 78















1775.10(c)(2) Assurances--Non-construction Programs SF-424B








Initial Submission (4040-0007) 82 1 142 0.25 36

Revised Submission
26 1 26 0.25 7















1775.10(c)(8) Equal Opportunity Agreement RD 400-1 45 1 45 0.17 8




(0575-0018)


















1775.10(c)(7) Assurance Agreement RD 400-4 45 1 45 0.25 11





(0575-0018)


















1775.18(a) Request for Advance or Reimbursement SF-270 35 12 420 1.00 420




(4040-0012) 10 4 40 1.00 40















1775.10(c)(11) Disclosure of Lobbying Activities SF LLL 45 1 45 0.25 11





(4040-0013)





















Federal Financial Report SF-425 45 4 180 1.50 270





(4040-0014)








RUS Form 36 (07-91)







Page __2__ of __2__













*Note: Applications: Private sector responses = 66. American Indian responses = 16. Total = 82










** Note: Obligations/Approvals: Private sector responses = 41; Tribal responses = 12; Total = 53










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