Summary Spreadsheet -Burden

USDA - RUS				Title of Information Document						OMB No.
				Rural e-Connectivity Pilot Program							0572-New
SUMMARY OF INFORMATION COLLECTION				(ReConnect Program)						Date Prepared
											Nov-18
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
	(a)					DENT						(Col. i & j)
Grants	Combos	Loans	(b)	(c)	(d)	(e)	(f)	(g)	(h)	(i)	(j)	(k)
			Items Cleared Under This Docket
			Applicant Information
			Funding Request	None	2,000	1	2,000	2.00
			Executive Summary	None	2,000	1	2,000	4.00	8,000
			Legal Opinion	None	2,000	1	2,000	2.00	4,000
			Organizational Charts	None	2,000	1	2,000	1.00	2,000
			Resumes of Key Management Personnel	None	2,000	1	2,000	1.00	2,000
			Broadband Operations Experience	None	2,000	1	1,000	1.00	1,000
			Proposed Funded Service Area Description	None	2,000	1	2,000	20.00	40,000
			Proposed Funded Service Area Map	None	2,000	1	2,000	4.00	8,000
			Subscriber Projections	None	2,000	1	2,000	10.00	20,000
			Competitive Analysis	None	2,000	1	2,000	8.00	16,000
			Network Design	None	2,000	1	2,000	40.00	80,000
			Licenses, Agreements, and Regulatory Approvals	None	2,000	1	2,000	10.00	20,000
			Summary and Itemized Budgets	None	2,000	1	2,000	20.00	40,000
			Pro Forma Financial Analysis	None	2,000	1	2,000	60.00	120,000
			Reconciliation Schedule (Co-applicants only)	None	100	1	100	20.00	2,000
			Sources of Other Funding	None	2,000	1	2,000	1.00	2,000
	N/A	N/A	Matching Requirement (required for 100 percent grant request only)	None	1,000	1	1,000	1.00	1,000
			Investor Proposals (Co-applicants only)	None	100	1	100	1.00	100
			List of Outstanding and Contingent Obligations	None	2,000	1	2,000	1.00	2,000
			Historical Financial Statements	None	2,000	1	2,000	1.00	2,000
			Audited Financial Statements	None	2,000	1	2,000	1.00	2,000
			Evaluation Criteria	None	2,000	1	2,000	20.00	40,000
			Environmental Information	None	2,000	1	2,000	10.00	20,000
			State-funded Areas Certification	None	2,000	1	2,000	2.00	4,000
			Certification of Investor Compliance	None	2,000	1	2,000	1.00	2,000
N/A	N/A		Acquisition Agreement (applicable to 100 percent loan request only)	None	40	1	40	3.00	120
			Certification of Tribal Support (if applicable)	None	40	1	40	5.00	200
			Substantially Underserved Trust Area Application (if applicable)	None	40	1	40	30.00	1,200
			Evidence of Legal Existence	None	2,000	1	2,000	2.00	4,000
			Certificate Regarding Architectural Barriers	None	2,000	1	2,000	0.25	500
			Certification Regarding Debarment, Suspension, and Other Responsibility Matters – Primary Covered Transactions	None	2,000	1	2,000	0.25	500
			Certificate Regarding Flood Hazard Area Precautions	None	2,000	1	2,000	0.25	500
			Certification Regarding Lobbying for Contracts, Grants, Loans and Cooperative Agreements	None	2,000	1	2,000	0.25	500
			Civil Rights Compliance Certification	None	2,000	1	2,000	0.25	500
			Federal Collection Policies for Commercial Debt Certification	None	2,000	1	2,000	0.25	500
			Lobbying Certification for Loan Guarantees and Loan Insurance	None	2,000	1	2,000	0.25	500
			Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 Certification	None	2,000	1	2,000	0.25	500
			Public Notice Filing Information
			Public Notice Responses	None	2,000	3	6,000	1.50	9,000
			Recipient Information
			Updated Information for the Preparation of Legal Documents	None	200	1	200	10.00	2,000
			Execution of Legal Documents	None	200	1	200	5.00	1,000
			Evidence of Fidelity Bond Coverage	None	200	1	200	2.00	400
			Evidence of First Lien	None	200	1	200	4.00	800
			Semiannual Performance Reports	None	200	1	200	5.00	1,000
			Annual Audited Financial Statements	None	200	1	200	10.00	2,000
			Annual Service Area Maps and Progress Report	None	200	1	200	10.00	2,000
			Final Service Area Map and Accomplishments	None	200	1	200	16.00	3,200
Total burden hours for forms approved under this OMB Docket 0572-XXXX					2,000	34.96	69,920	6.77	473,020
			FORMS APPROVED UNDER OTHER OMB DOCKETS
			Forms approved under OMB Docket No.0505-0025
		5 U.S.C. 552(a), as amended	Representations Regarding Felony Conviction (AD 3030) - For Corporations Only	AD 3030	2,000	1	2,000	0.25	500
		5 U.S.C. 552(a), as amended	Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants (AD 3031)	AD 3031	2,000	1	2000	0.05	100
			Forms approved under OMB Docket No. 0572-0059
			Construction Certification Program
			Engineering and Architectural Services
		1753	Postloan Engineering Service Contract	217	200	1	200	7.00	1,400
		Subpart B	● Approval of Postloan Engineering Service Contract
			The Postloan Eng. Serv. Contract incl. using the following forms:
			RUS Form 217a-Project Design, Assistance and Coordination:
			RUS Form 217b-Central Office Equipment Engineering Services;
			RUS Form 217c-Transmission Facilities Engineering Services;
			RUS Form 217d-Building Engineering Services;
			RUS Form 217e-Outside Plant Staking Services;
			RUS Form 217f-Outside Plant Contract Doc. Phase Engr. Servs.
			RUS Form 217g-Outside Plant Construction Phase Engr. Servs.
			RUS Form 216 - Construction Change Order	216	200	1	200	1.00	200
			RUS Form 526 – Construction Contract Amendment	526	200	1	200	3.00	600
			RUS Form 270 - Equal Opportunity Addendum	270	200	1	200	0.15	30
			Miscellaneous Engineering Services Forms
		1753.15,	Engineering Service Contract - Special Services - Telephone	245	200	1	200	0.75	150
		81	● Engineering services for minor construction may be
			contracted using Form 245 (This contract form does not
			require RUS approval).
		175349	Tabulation of Materials Furnished by Borrower
			● Closeout of major outside plans construction by contract.	281	200	4	800	2.00	1,600
		1753.8(b)	Subcontracts (Under Construction or Equipment)
			● Approval of subcontracts (per 1753.8(b))	282	200	2	400	0.75	300
		1753.16	Certificate of Architect
			● Approval of final statement of cost-architectural services	284	200	1	200	0.50	100
		1753.17	Statement of Engineering Fees - Telecommunications
			● Estimates	506	200	1	200	6.00	1,200
		1753.17	● Final		200	1	200	6.00	1,200
			Major Outside Plant Construction
			Telephone System Construction Contract (Labor and Materials)
		1753.47	● Approval of plans and specifications for major outside	515
			plant construction by contract		200	1	200	4.00	800
		1753.48	● Approval of the outside plant contract		200	1	200	6.00	1,200
		1753.48	● Owner-Furnished Materials -Info. Included under RUS Form 787 below
		1753.48	● Approval of negotiated contracts		200	1	200	2.00	400
			Miscellaneous Outside Plant Construction Forms
		1753.49	Final Inventory, Telephone Construction Contract
			(Labor and Materials)	724	200	2	400	0.75	300
			● Closeout of major outside plant construction by contract
		1753.49	Final Inventory, Telephone Construction Contract
			(Labor and Materials) - Detailed	724a	200	2	400	3.00	1,200
			● Tabulation of Assembly Units
		1753.49	Final Inventory, Telephone Construction Contract
			(Labor and Materials) - Detailed	724b	200	2	400	0.75	300
			● Removals
		1753.18	Contract Closeout Certification	756	200	1	200	0.50	100
		1753.81-82	Summary of Work Order
			Inspection by licensed Engineer or Borrower's Staff Engineer	771a	200	2	400	0.50	200
		1753	Miscellaneous Construction Work and Maintenance
			Service Contract	773
			● Issued for minor construction by contract		200	2	400	3.00	1,200
		1753.48 (f)	Supplement A to Construction Contract RUS Form 515	787	200	5	1000	0.25	250
			● Approval for the borrower to furnished materials for outside
			plant construction by contract
		1753.15	Preloan Engineering Service Contract, Telephone
		(a)(2)	System Design	835	200	1	200	0.75	150
			Forms approved under OMB Docket No. 0572-0149
		1753	Equipment Contract	395	200	2	400	1.50	600
		Subpart E, H
		1753.37, 38,	Certificate of Completion, Equipment Contract	395a	200	1	200	0.50	100
		39, 68	(Including Installation)
		1753.37, 38,	Certificate of Completion, Equipment Contract	395b	200	1	200	0.50	100
		39, 68	(Not Including Installation)
			Forms approved under OMB Docket No. 0572-0107
		1753, 1788	Contractor's Bond	168b	200	2	400	0.02	6.4
		1753.30	Certificate of Completion - Contract Construction for Building	181	200	1	200	0.10	20
			Closeout of Contract Form 257 for Building Construction.
		1753	Certificate ("Buy American")	213	200	1	200	0.02	3.2
			RUS Form 224 -Waiver and Release	224	200	1	200	0.01	2.0
			RUS Form 743 - Certificate of Contractor and Indemnity Agreement	743	200	1	200	0.01	2.0
		1753.30,	Certificate of Contractor	231	200	1	200	0.02	3.2
		39, 49
		1753.11,	Construction or Equipment Contract Amendment	238	200	2	400	0.02	6.4
		28, 38, 68
		1753	Contract to Construct Building	257	200	1	200	0.08	16.6
		Subpart D
			Bid Bond	307	200	2	400	0.02	6.4
			Form approved under OMB Docket No. 0572-0023
		1744.66	Financial Requirements Statement	481	200	3	600	2.00	1200
			Form approved under OMB Docket No. 0572-0074
		1744.66	Certification of Authority	675	200	2	400	0.10	40
			Form approved under OMB Docket No. 0572-0118
		Subpart B	Architectural Services Contract	220	200	1	200	1.00	200
			Form approved under OMB Docket No. 0572-0142
		1773.4	Selection of CPA	n/a	200	1	200	0.25	50
		1773	Submission of Auditor's Report	n/a	200	1	200	11.00	2,200
			Plan of Corrective Action	n/a	200	1	200	0.25	50
			Submission of Peer Review Reports	n/a	200	1	200	0.25	50
			Scope Limitation	n/a	200	1	200	0.25	50
			Irregularities	n/a	5	1	5	2.00	10
			Quartertly Submission of Financial Information through BCAS	n/a	200	4	800	4.00	3,200
		1770	Index of Records and Recordkeeping	n/a	200	1	200	2.00	400
		Subpart A
		1770	GAAP System of Accounts	n/a						200	24	4,800
		Subpart B
		Total burden hours for forms approved under other OMB Dockets			200	66	13,205	1.61	21,196.2	200		4,800
											Page __1__ of __1__
							Annual Burden Hours		473,020
							Record Keeping Hours		4,800
			TOTAL ANNUAL BURDEN AND RECORDKEEPING HOURS				Total Burden Hours		477,820
RUS Form 36 (07-91)