| USDA - RUS |
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Assistance to High Energy Cost Rural Communities |
OMB No. |
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0572-0136 |
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| SUMMARY OF INFORMATION COLLECTION |
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Date Prepared |
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01/17/17 |
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| INSTRUCTIONS: |
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> |
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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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> |
- |
= (e) Average |
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= (g) Average |
- |
= (j) Average |
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| recordkeeping requirements. |
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> |
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(f) TOTAL |
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(i) TOTAL |
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| IDENTIFICATION OF REPORTING AND RECORDKEEPING 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 |
| SECTION OF |
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(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 |
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RESPOND- |
(Col. d & e) |
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KEEPER |
HOURS |
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DENT |
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(Col. i & j) |
| (a) |
(b) |
(c) |
(d) |
e |
(f) |
(g) |
(h) |
(i) |
(j) |
(k) |
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ITEMS APPROVED UNDER THIS COLLECTION |
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Narrative Grant Proposal Application |
Non-Form |
60 |
1.00 |
60 |
10 |
600.00 |
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RUS Environmental Profile |
Non-Form |
60 |
1.00 |
60 |
1 |
60.00 |
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Grant Award and Post Award (Selected from 60 applicant respondents) |
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Grant Agreement |
Non-Form |
12 |
1.00 |
12 |
1 |
12.00 |
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Performance Reports |
Non-Form |
40 |
4.00 |
160 |
2 |
320.00 |
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Final Performance Report |
Non-Form |
12 |
1.00 |
12 |
5.0 |
60.00 |
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Recordkeeping Requirements |
Non-Form |
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40 |
3 |
120 |
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Subtotal this Collection |
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100 |
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304 |
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1,052 |
40 |
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120 |
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TOTALS |
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344 |
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1,172 |
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FORMS APPROVED UNDER OTHER COLLECTIONS |
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Application for Federal Assistance |
SF-424 |
60 |
1.00 |
60 |
0.75 |
45.00 |
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Budget Information Non-Construction Programs or |
SF-424A |
60 |
1.00 |
60 |
1 |
60.00 |
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Budget Information Construction Programs |
SF-424C |
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Assurances Non-Construction Programs or |
SF-424B |
60 |
1.00 |
60 |
0.25 |
15.00 |
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Assurances Construction Programs |
SF-424D |
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Assurance Re: Felony Conviction (0505-0025) |
AD-3031 |
60 |
1.00 |
60 |
0.05 |
3.00 |
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Page __1__ of __2__ |
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Letter of Intent (0575-0015) |
RD 1942-46 |
12 |
1.00 |
12 |
1.00 |
12.00 |
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Certification Regarding Debarment, Suspension, etc. |
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60 |
1.00 |
60 |
0.05 |
3.00 |
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Disclosure of Lobbying Activities |
SF-LLL |
60 |
1.00 |
60 |
0.17 |
10.20 |
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Post Award |
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Federal Financial Report |
SF-425 |
40 |
4.00 |
160 |
1.50 |
240.00 |
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Request for Reimbursement or Advance of Funds of |
SF-270 |
40 |
4.00 |
160 |
1.00 |
160.00 |
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Outlay Report and Request for Reimbursement (Const.) |
SF-271 |
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1 |
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| RUS Form 36 (07-91) |
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Page __2__ of __2__ |
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