Spreadsheet

USDA - RUS		Title of Information Document						OMB No.
		Rural Alaska Village Grant Program (RAVG) - (Associated with a final rule)						0572-0150
SUMMARY OF INFORMATION COLLECTION								Date Prepared
								18-Mar-21
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-
NOFA	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)
	Application Submission Forms Approved under this Package
1784.21(b)(3)	Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions	AD-1047	36	1	36	0.25	9
1784.21(b)(4)	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Transaction.”	AD-1048	36	1	36	0.25	9
1784.21(b)(5)	Certification Regarding Drug-Free Workplace	AD-1049	36	1	36	0.25	9
	Subtotal:		36		108		27
	Writen Non-Forms - Burden Approved under this Package
1784.21(b)(8)	Certification for Contracts, Grants and Loans Regarding Lobbying	RD Instr. 1940-Q, Exhibit A-1	36	1	36	0.25	9
1784.19(a)(2)	Preliminary Engineering Report	Written	36	1	36	4.00	144
1784.21(b)(9)	Certification Regarding Prohibited Tying Arrangements	Written	36	1	36	0.25	9
1784.19(a)(5)	Business Plan	Written	24	1	24	4.00	96
1784.19	Land Surveyors Certification and Opinion of Right of Way	Written	24	1	15	1.00	15
1784.27(a)	Grant Agreement - (The two grant agreements specific to RAVG program participants and the associated burden are included)..	RUS Bulletin 1780-12	19	1	19	1.00	19
1784.28	Audits	Written	19	1	19	8.00	152
1784.(36)(b)	Approved Contract Documents	Written	12	1	12	4.00	48
1784.21(b)(6)	Civil Rights Compliance Assurance	Written	19	1	19	0.25	4
	Subtotal:				216		496
	ESTIMATED TOTAL FOR THIS COLLECTION		36		324		523			Page 1
	FORMS APPROVED UNDER OTHER OMB NUMBERS
1784.21(b)(1)	Equal Opportunity Agreement	RD 400-1 (OMB#: 0575-0018)	36	1	36	0.08	3
1784.19	Opinion of Counsel Relative to Right-of-Way & Easements	RD 442-22 (OMB#: 0575-0015)	12	1	12	1.00	12
1784.17
1784.18(a)	Application for Federal Assistance	SF 424	36	1	36	1.00	36
1784.19(a)(1)		(4040-0004)
1784.21(b)(2)	Assurance Agreement	RD 400-4 (OMB#: 0575-0018) (OMB#: 0570-0062)	19	1	19	0.25	5
1784.21(e)	Letter of Intent to Meet Conditions	RD 1942-46 (OMB#: 0575-0015); (OMB#: 0570-0021); (OMB#: 0570-0061); (OMB#: 0570-0062); (OMB#: 0572-0137)	19	1	19	1.00	19
1784.18(a)	Budget Information - Non-construction Programs	SF 424A	19	1	19	1.00	19
		(4040-0006)
1784.18(a)	Assurances - Non-construction Programs	SF 424B (4040-0007)	12	1	12	0.25	3
1784.19(a)(1)	Budget Information - Construction Programs	SF 424C	19	1	19	1.00	19
		(4040-0008)
1784.19(a)(1)	Assurances - Construction Programs	SF 424D	19	1	15	0.25	4
		(4040-0009)
1784.21(b)(7)	Disclosure of Lobbying Acitivities	SF LLL (4040-0013)	12	1	12	0.25	3
1784.21(b)(6)	Compliance Assurance	RUS Form 266 (0572-0032)	19	1	19	0.50	10
	Total burden associated with OTHER packages				218	1.31	132			Page 2
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