OMB 83-i

PAPERWORK REDUCTION ACT SUBMISSION
Please read the instructions before completing this form. For additional forms or assistance in completing this form, contact your
agency's Paperwork Clearance Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting
Statement, and any additional documentation to: Office of Information and Regulatory Affairs, Office of Management and Budget,
Docket Library, Room 10102, 725 17th Street NW, Washington, DC 20503.
2. OMB CONTROL NUMBER

1. AGENCY/SUBAGENCY ORIGINATING REQUEST

Rural Utilities Service (RUS)
a.

4. TYPE OF REVIEW REQUESTED (X one)

3. TYPE OF INFORMATION COLLECTION (X one)
(For b. - f., note Item A2 of Supporting Statement instructions)

X

a. NEW COLLECTION

X

b. NONE

0051

0572

a. REGULAR SUBMISSION
b. EMERGENCY - APPROVAL REQUESTED BY:

b. REVISION OF A CURRENTLY APPROVED COLLECTION

c. DELEGATED

c. EXTENSION OF A CURRENTLY APPROVED COLLECTION
d. REINSTATEMENT, WITHOUT CHANGE, OF A PREVIOUSLY
APPROVED COLLECTION FOR WHICH APPROVAL HAS EXPIRED

5. SMALL ENTITIES
Will this information collection have a significant economic
impact on a substantial number of small entities?

e. REINSTATEMENT, WITH CHANGE, OF A PREVIOUSLY
APPROVED COLLECTION FOR WHICH APPROVAL HAS EXPIRED

6. REQUESTED EXPIRATION DATE

YES

X

f. EXISTING COLLECTION IN USE WITHOUT AN OMB CONTROL
NUMBER

X

NO

a. THREE YEARS FROM APPROVAL DATE
b. OTHER:

7. TITLE

RUS Form 87, Request for Mail List Data
8. AGENCY FORM NUMBER(S) (if applicable)

Form 87
9. KEYWORDS

10. ABSTRACT

The RUS Form 87 is used for both the Rural Utilities Service Electric and Telecommunications programs to obtain the names and
addresses of the borrowers' officials with whom they must communicate directly in order to administer the Agency's lending
programs.
12. OBLIGATION TO RESPOND (X one)

11. AFFECTED PUBLIC (Mark primary with "P" and all others that apply with "X")

X

a. VOLUNTARY

a. INDIVIDUALS OR HOUSEHOLDS

d. FARMS

b. BUSINESS OR OTHER FOR-PROFIT

e. FEDERAL GOVERNMENT

c. NOT-FOR-PROFIT INSTITUTIONS

f. STATE, LOCAL OR TRIBAL GOVERNMENT

13. ANNUAL REPORTING AND RECORDKEEPING HOUR BURDEN
a. NUMBER OF RESPONDENTS
(1) Percentage of these responses collected electronically

246
245
1
+1
+246

d. CURRENT OMB INVENTORY
e. DIFFERENCE (+, -)
EXPLANATION OF
DIFFERENCE:

(1) Program change (+, -)
(2) Adustment (+, -)

15. PURPOSE OF INFORMATION COLLECTION (Mark primary with

a. TOTAL CAPITAL/STARTUP COSTS

a. APPLICATION FOR BENEFITS

d. CURRENT OMB INVENTORY
e. DIFFERENCE (+, -)
f.

c. GENERAL PURPOSE STATISTICS
d. AUDIT

17. STATISTICAL METHODS
Does this information collection employ
statistical methods?
YES

OMB FORM 83-I, 10/95

X

NO

EXPLANATION OF DIFFERENCE:
(1) Program change (+, -)

0.00
0.00

(2) Adustment (+, -)

16. FREQUENCY OF RECORDKEEPING OR REPORTING (X all that apply)
a. RECORDKEEPING

e. PROGRAM PLANNING
OR MANAGEMENT

b. PROGRAM EVALUATION

0.00
0.00
0.00
0
0

b. TOTAL ANNUAL COSTS (O&M)

"P" and all others that apply with "X")

X

c. MANDATORY

c. TOTAL ANNUALIZED COST REQUESTED

c. TOTAL ANNUAL HOURS REQUESTED

f.

b. REQUIRED TO OBTAIN OR RETAIN BENEFITS

14. ANNUALIZED COST TO RESPONDENTS (In thousands of dollars)

985
985

b. TOTAL ANNUAL RESPONSES

X

X

b. THIRD PARTY DISCLOSURE

c. REPORTING:

f. RESEARCH
g. REGULATORY OR
COMPLIANCE

X

(1) On Occasion

(2) Weekly

(3) Monthly

(4) Quarterly

(5) Semi-Annually

(6) Annually

(7) Biennially

(8) Other (Describe)

18. AGENCY CONTACT (Person who can best answer questions regarding the content of this
submission)
a. NAME (Last, First, Middle Initial)

Mussington, Arlette A

b. TELEPHONE NUMBER (Include
area code)

(202) 720-2825

OMB CONTROL NUMBER

0572

0051

TITLE

RUS Form 87, Request for Mail List Data

19. CERTIFICATION FOR PAPERWORK REDUCTION ACT SUBMISSIONS
a. PROGRAM OFFICIAL CERTIFICATION
(1) Signature

(2) Date

02/05/2020

Arlette Mussington

On behalf of this Federal agency, I certify that the collection of information encompassed by this request
complies with 5 CFR 1320.9.
NOTE: The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of the
instructions. The certification is to be made with reference to those regulatory provisions as set forth in the
instructions.
The following is a summary of the topics, regarding the proposed collection of information, that the
certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8(b)(3) about:
(i)

Why the information is being collected;

(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective
management and use of the information to be collected (see note in Item 19 of the instructions);
(i) If applicable, it uses effective and efficient statistical survey methodology; and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item below and explain the
reason in Item 18 of the Supporting Statement.

b. SENIOR OFFICIAL OR DESIGNEE CERTIFICATION
(1) Signature

OMB FORM 83-I (BACK), 10/95

(2) Date