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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 210082 under ICR 202202-0572-003 · OMB 0572-0149.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 395
New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers		 Form
Form 395
RUS Contract Form 395 New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers		 Form
Form 395a
RUS Form 395a - CERTIFICATE OF COMPLETION New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers		 Form
Form 395b
RUS Form 395b - Certificate of Completion New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers		 Form
Form 395c
RUS Form 395c - Certificate of Seller New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers		 Form
Form 395d
RUS Form 395d - Results Of Equiptment Tests New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers		 Form
Form AD 1048
Debarment Certificate - Lower Tier Covered New Equipment Contract (RUS Contract Form 395) for Telecommunications and Broadband Borrowers		 Form
This is a place holder for the following non-form reporting requirements.docx Other-Non Form
This is a place holder for the following non-form reporting requirements.docx Other-Non Form
395 RUS Contract Form 395
RUS 395.pdf
www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom 		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 		Form
395a RUS Form 395a - CERTIFICATE OF COMPLETION
Form 395a FINAL.docx 		Form
395b RUS Form 395b - Certificate of Completion
RUS 395b.pdf 		Form
395b RUS Form 395b - Certificate of Completion
RUS 395b.pdf 		Form
395c RUS Form 395c - Certificate of Seller
RUS 395c.pdf 		Form
395c RUS Form 395c - Certificate of Seller
RUS 395c.pdf 		Form
395d RUS Form 395d - Results Of Equiptment Tests
RUS 395d.pdf 		Form
395d RUS Form 395d - Results Of Equiptment Tests
RUS 395d.pdf 		Form
AD 1048 Debarment Certificate - Lower Tier Covered
AD-1048 DebarmentCert-LowerTierCovered.pdf 		Form
AD 1048 Debarment Certificate - Lower Tier Covered
AD-1048 DebarmentCert-LowerTierCovered.pdf 		Form

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 395 http://www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom Yes No Printable Only
Form 395a tp://www.rurdev.usda.gov/UP_ETPW_Forms.html#Telecom Yes No Printable Only
Form 395b http://www/rurdev.usda.gov/UP_ETPW_Forms.html#telecom Yes No Printable Only
Form 395c http://www/rurdev.usda.gov/UP_ETPW_Forms.html#Telecom Yes No Printable Only
Form 395d http://www/rurdev.usda.gov/UP_ETPW_Forms.html#Telecom Yes No Printable Only
Form AD 1048 Yes Yes Fillable Fileable
Other-Non Form Yes Yes Fillable Printable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 161 0 -74 0 0 235
Annual IC Time Burden (Hours) 114 0 -46 0 0 160
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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