excel worksheet

USDA - RUS		Title of Information Document						OMB No.
		Form 395 - Equipment Contract for Telecommunications							0572-0149
SUMMARY OF INFORMATION COLLECTION		and Broadband Borrowers						Date Prepared
								3/19/2019
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 RECORDKEEPING 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)
1753	Equipment Contract	395	33	1.7	56.1	1.50	84.15
Subpart E, H
1753.3 and 6	Borrower's non-conformance request letter	Written	5	1	5	1.00	5.00
Subpart A	(construction, design, materials, equipment, etc..)
1753.37, 38,	Certificate of Completion, Equipment Contract	395a	28	1.4	39.2	0.50	19.60
39, 68	(Including Installation)
1753.37, 38,	Certificate of Completion, Equipment Contract	395b	9	1.4	12.6	0.50	6.30
39, 68	(Not Including Installation)
1753.37, 38,	Certificate of Contractor and Indemnity Agreement	395c	28	1	28	0.50	14.00
39, 68	(Use only for installation contracts)
1753.37, 38,	Report in writing, including all measurements, any	395d	28	1	28	0.75	21.00
39, 68	acceptance test report and other information required under
	Part II of applicable specifications
1753	Certification Regarding Debarment, Suspension, Ineligibility	AD1048	33	1	33	0.25	8.25
Subpart E, H	and Voluntary Exclusion - Lower Tier Covered Transactions
1753	Lobbying Certification (Telephone Version 3, 8/11)	Written	33	1	33	0.05	1.65
Subpart E, H
	TOTALS		33		235	0.68	160
	FORMS APPROVED UNDER OTHER OMB NUMBERS
1753	Certificate ("Buy American")	213	33	1	33	0.016	0.53
		0572-0107
1753.11,	Construction or Equipment Contract Amendment	238	19	2.2	41.8	0.016	0.67
28, 38, 68		0572-0107
1784.20(b)(7)	Disclosure of Lobbying Acitivities	SF LLL	1	1	1	0.25	0.25
		(0348-0046)
	Total burden associated with OTHER packages				76	0.02	1
	Total burden hours associated with THIS package				235	0.68	160
	COMBINED burden associated with this package				311	0.52	161