New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers

New Equipment Contract (Form 395) for Telecommunications and Broadband Borrowers

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0149 can be found here:

Documents and Forms

Document Name Document Type
Form 395 New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers Form
395 RUS Contract Form 395 RUS 395.pdf www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom Form
395a RUS Form 395a - CERTIFICATE OF COMPLETION Form 395a FINAL.docx tp://www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom Form
395b RUS Form 395b - Certificate of Completion RUS 395b.pdf www/rurdev.usda.gov/UP_ETPW_Forms.html#telecom Form
395c RUS Form 395c - Certificate of Seller RUS 395c.pdf www/rurdev.usda.gov/UP_ETPW_Forms.html#Telecom Form
395d RUS Form 395d - Results Of Equiptment Tests RUS 395d.pdf www/rurdev.usda.gov/UP_ETPW_Forms.html#Telecom Form
AD 1048 Debarment Certificate - Lower Tier Covered AD-1048 DebarmentCert-LowerTierCovered.pdf Form

Information Collection (IC) Details

IC Title:	New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 1755 7 CFR 1753

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	395	RUS Contract Form 395	RUS 395.pdf	http://www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Yes	No	Printable Only
Form	395a	RUS Form 395a - CERTIFICATE OF COMPLETION	Form 395a FINAL.docx	tp://www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Yes	No	Printable Only
Form	395b	RUS Form 395b - Certificate of Completion	RUS 395b.pdf	http://www/rurdev.usda.gov/UP_ETPW_Forms.html#telecom	Yes	No	Printable Only
Form	395c	RUS Form 395c - Certificate of Seller	RUS 395c.pdf	http://www/rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Yes	No	Printable Only
Form	395d	RUS Form 395d - Results Of Equiptment Tests	RUS 395d.pdf	http://www/rurdev.usda.gov/UP_ETPW_Forms.html#Telecom	Yes	No	Printable Only
Form	AD 1048	Debarment Certificate - Lower Tier Covered	AD-1048 DebarmentCert-LowerTierCovered.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 33	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	235	-1,172	1,407
Annual IC Time Burden (Hours)	160	-730	890
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.