Summary of Burden - Spreadsheet (Form 36)

HWWS 0572-0139 spreadsheet 10-26-17.xls

7 CFR 1776, Household Water Well System Grant Program

Summary of Burden - Spreadsheet (Form 36)

OMB: 0572-0139

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USDA - RUS
Title of Information Document




OMB No.









0572-0139
SUMMARY OF INFORMATION COLLECTION






Date Prepared


7 CFR 1776 Household Water System Program






October, 2017
INSTRUCTIONS:

> (f) TOTAL
(h) TOTAL
(k) 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 (by regulation reference)




















Initial Application/Application Processing



















1776.2 and RD Inst. 1900-D Identify Employee Relationship Written 7 1 7 0.25 1.75


1776.5 Organizational Documents-Evidence of Legal Existence and Authority Written 7 1 7 0.25 1.75


1776.5 List of Directors and Officers Written 7 1 7 0.25 1.75


1776.5 Evidence of Tax Exempt Status Written 7 1 7 0.25 1.75


1776.7 (b) Work Plan (Project Proposal, Work Plan, and Budget Justification) Written 7 1 7 80.00 560.00


1776.7(c) Statement of Experience Written 7 1 7 4.00 28.00


1776.9 (d) (1) Pro-forma Balance Sheet Written 7 1 7 4.00 28.00


1776.7 (d) (2) Prior year Audit / Financial Statement Written 7 1 7 0.25 1.75


1776.7 (d) (3) Pro-forma Income Statement and Cash Flow Written 7 1 7 4.00 28.00














Post Application



















1776.2, 3019.26 and 3052 Annual Audit / Financial Statement Written 7 1 7 0.25 1.75


1776.2 and 3019.51 Project Performance Report Written








Initial
7 4 28 2.00 56.00



Extension
4 4 16 2.00 32.00


1776.2 and 3019.25 Request written approval of workplan changes Written 4 1 4 2.00 8.00


1776.10 Grant Agreement Written 7 1 7 2.00 14.00













1776.2 and 3017.335 Cert. Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions (Cleared under 0505-0027) AD 1047 7 1 7 0.25 1.75


1776.2 and 3017.335 Cert. Regarding Debarment, Suspension, and other Responsibility Matters- Lower Tier Transactions (Cleared under 0505-0027) AD 1048 7 1 7 0.25 1.75


1776.2 and 3021.23 Cert. Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees Other Than Individuals (Cleared under 0505-0027) AD 1049 7 1 7 0.25 1.75



Total for this Package
7
146.00
769.75














Items Cleared Under Other Packages (by form number)



















1776.2 Equal Opportunity Agreement (Cleared under 0575-0018) RD 400-1 7 1 7 0.17 1.19


1776.2 Assurance Agreement (Cleared under 0575-0018) RD 400-4 7 1 7 0.25 1.75


1776.2 and 3018.11 Disclosure of Lobbying Activities-(Cleared under 4040-0013) SF-LLL 7 1 7 0.25 1.75


1776.2 and 3019.22 Request for Advance or Reimbursement - (Cleared under 4040-0012) SF 270








Initial
7 12 84 1.00 84.00



Extension
4 12 48 1.00 48.00


1776.7 (a)(1) Application for Federal Assistance (Cleared under 4040-0004) SF-424








Initial
7 1 7 0.75 5.25



Revised
7 1 7 0.75 5.25


1776.9(a)(2) Budget Information - (Cleared under 4040-0006) SF-424A








Initial
7 1 7 3.00 21.00



Revised
7 1 7 3.00 21.00


1776.9(a)(3) Assurances - Non Construction Programs - (Cleared under 4040-0007) SF-424B 7 1 7 0.25 1.75
1776.2 and 3019.52 Federal Financial Report - (Cleared under 4040-0014) SF-425








Initial
7 4 28 1.50 42.00



Extension
4 4 16 1.50 24.00














Total for items cleared unter other Packages
7
232.00
257

File Typeapplication/vnd.ms-excel
Authorcheryl.francis
Last Modified ByParker, Charlene - OCIO
File Modified2017-10-25
File Created2011-02-01

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