Summary of Burden - Spreadsheet (Form 36)

USDA - RUS		Title of Information Document						OMB No.
									0572-0139
SUMMARY OF INFORMATION COLLECTION								Date Prepared
	7 CFR 1776 Household Water System Program								October, 2017
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
				DENT						(Col. i & j)
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)	(i)	(j)	(k)
	Items Cleared With This Package (by regulation reference)
	Initial Application/Application Processing
1776.2 and RD Inst. 1900-D	Identify Employee Relationship	Written	6	1	6	0.25	1.50
1776.5	Organizational Documents-Evidence of Legal Existence and Authority	Written	6	1	6	0.25	1.50
1776.5	List of Directors and Officers	Written	6	1	6	0.25	1.50
1776.5	Evidence of Tax Exempt Status	Written	6	1	6	0.25	1.50
1776.7 (b)	Work Plan (Project Proposal, Work Plan, and Budget Justification)	Written	6	1	6	80.00	480.00
1776.7(c)	Statement of Experience	Written	6	1	6	4.00	24.00
1776.9 (d) (1)	Pro-forma Balance Sheet	Written	6	1	6	4.00	24.00
1776.7 (d) (2)	Prior year Audit / Financial Statement	Written	6	1	6	0.25	1.50
1776.7 (d) (3)	Pro-forma Income Statement and Cash Flow	Written	6	1	6	4.00	24.00
	Post Application
1776.2, 3019.26 and 3052	Annual Audit / Financial Statement	Written	5	1	5	0.25	1.25
1776.2 and 3019.51	Project Performance Report	Written
	Initial		6	4	24	2.00	48.00
	Extension		4	4	16	2.00	32.00
1776.2 and 3019.25	Request written approval of workplan changes	Written	4	1	4	2.00	8.00
1776.10	Grant Agreement	Written	6	1	6	2.00	12.00
1776.2 and 3017.335	Cert. Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions (Cleared under 0505-0027)	AD 1047	7	1	7	0.25	1.75
1776.2 and 3017.335	Cert. Regarding Debarment, Suspension, and other Responsibility Matters- Lower Tier Transactions (Cleared under 0505-0027)	AD 1048	7	1	7	0.25	1.75
1776.2 and 3021.23	Cert. Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees Other Than Individuals (Cleared under 0505-0027)	AD 1049	7	1	7	0.25	1.75
	Total for this Package		7		130.00		666.00
	Items Cleared Under Other Packages (by form number)
1776.2	Equal Opportunity Agreement (Cleared under 0575-0018)	RD 400-1	6	1	6	0.17	1.02
1776.2	Assurance Agreement (Cleared under 0575-0018)	RD 400-4	6	1	6	0.25	1.50
1776.2 and 3018.11	Disclosure of Lobbying Activities-(Cleared under 4040-0013)	SF-LLL	6	1	6	0.25	1.50
1776.2 and 3019.22	Request for Advance or Reimbursement - (Cleared under 4040-0012)	SF 270
	Initial		6	12	72	1.00	72.00
	Extension		6	12	72	1.00	72.00
1776.7 (a)(1)	Application for Federal Assistance (Cleared under 4040-0004)	SF-424
	Initial		6	1	6	0.75	4.50
	Revised		6	1	6	0.75	4.50
1776.9(a)(2)	Budget Information - (Cleared under 4040-0006)	SF-424A
	Initial		6	1	6	3.00	18.00
	Revised		6	1	6	3.00	18.00
1776.9(a)(3)	Assurances - Non Construction Programs - (Cleared under 4040-0007)	SF-424B	6	1	6	0.25	1.50
1776.2 and 3019.52	Federal Financial Report - (Cleared under 4040-0014)	SF-425
	Initial		6	4	24	1.50	36.00
	Extension		6	4	24	1.50	36.00
	Total for items cleared unter other Packages		6		240.00		267