| USDA - RUS |
|
|
|
|
|
|
|
OMB No. |
|
|
|
|
|
|
|
|
|
|
0572-0157 |
|
|
| SUMMARY OF INFORMATION COLLECTION |
|
7 CFR 1775 Technical Assistance and Construction for Innovative Regional Wastewater Treatment Solutions grant program
|
Date Prepared |
|
|
|
|
|
|
|
|
|
|
|
July 2024 |
|
| INSTRUCTIONS: |
|
|
|
> |
(f) TOTAL |
|
(h) 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 |
(F x G) |
KEEPERS |
RECORD- |
KEEPING |
|
|
|
|
|
RESPON- |
(D x E) |
|
|
|
KEEPER |
HOURS |
|
|
|
|
|
DENT |
|
|
|
|
|
(Col. i & j) |
|
| (a) |
(b) |
(c) |
(d) |
(e) |
(f) |
(g) |
(h) |
(i) |
(j) |
(k) |
|
|
Items Cleared Under This OMB Control Numbe * |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Initial Application/Application Process |
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(6) |
Documentation of Assistance Provided to Rural Development Employees |
Written |
9 |
1 |
9 |
0.313 |
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(9) |
Indirect Cost Rate Agreement |
Written |
9 |
1 |
9 |
1.250 |
11 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(10) |
Statement of Compliance , Title VI of Civil Rights Act of 1964 |
Written |
9 |
1 |
9 |
1.625 |
15 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10 |
Statement Concerning Assistance Under the National Forest Service-Dependent Rural Communities Economic Diversification Act |
Written |
9 |
1 |
9 |
1.625 |
15 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(1) |
Evidence of Legal Existence and Authority |
Written |
9 |
1 |
9 |
0.313 |
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(3) |
Narrative |
Written |
9 |
1 |
9 |
2.500 |
23 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(8) |
Scope of Work |
Written |
9 |
1 |
9 |
15.000 |
135 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(6) |
Budget Justification |
Written |
9 |
1 |
9 |
12.500 |
113 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(4) |
Balance Sheets and latest Financial Information |
Written |
9 |
1 |
9 |
1.250 |
11 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(d)(7) |
Evidence of Financial Management System |
Written |
9 |
1 |
9 |
3.125 |
28 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sub-total |
|
9 |
|
90 |
|
356 |
|
|
|
|
|
Post-Application |
|
|
|
|
|
|
|
|
|
|
| 1775.13 |
Grant Agreement |
RUS Guide 1775-1 |
1 |
1 |
1 |
2.500 |
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.2 |
Project Performance Report |
Written |
1 |
4 |
4 |
15.000 |
60 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.21 |
Audit |
Written |
1 |
1 |
1 |
3.750 |
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.21 |
Financial Statements |
Written |
1 |
1 |
1 |
1.250 |
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sub-total |
|
1 |
|
7 |
|
68 |
|
|
|
|
|
Items Cleared for this Package Combined Total |
|
9 |
|
97 |
|
423 |
|
|
|
|
|
|
|
Average Response Hours |
4.4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Items Cleared Under Other OMB Docket Numbers |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(3) |
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions |
AD-1047 (0505-0027) |
9 |
1 |
9 |
0.313 |
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(5) |
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Transaction.” |
AD-1048 (0505-0027) |
9 |
1 |
9 |
0.313 |
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(4) |
Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees Other Than Individuals |
AD-1049 (0505-0027) |
9 |
1 |
9 |
0.313 |
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
PAGE 1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants |
AD-3030 |
9 |
1 |
9 |
0.313 |
3 |
|
|
|
|
|
|
(0505-0025) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assurances Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants |
AD-3031 |
9 |
1 |
9 |
0.625 |
6 |
|
|
|
|
|
|
(0505-0025) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(1) |
Application for Federal Assistance |
SF-424 |
1 |
1 |
26 |
0.938 |
24 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(2) |
Budget Information--Non-Construction Programs |
SF-424A |
1 |
1 |
26 |
3.750 |
98 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(2) |
Assurances--Non-construction Programs |
SF-424B |
1 |
1 |
26 |
0.313 |
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(8) |
Equal Opportunity Agreement |
RD 400-1 |
9 |
1 |
9 |
0.213 |
2 |
|
|
|
|
|
|
(0575-0018) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(7) |
Assurance Agreement |
RD 400-4 |
9 |
1 |
9 |
0.313 |
3 |
|
|
|
|
|
|
(0575-0018) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.10(c)(11) |
Disclosure of Lobbying Activities |
SF LLL |
9 |
1 |
9 |
0.313 |
3 |
|
|
|
|
|
|
(4040-0013) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 1775.18(a) |
Request for Advance or Reimbursement (Corporation) |
SF-270 |
1 |
12 |
12 |
1.250 |
15 |
|
|
|
|
| |
|
(4040-0012) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Federal Financial Report |
SF-425 |
1 |
4 |
4 |
1.875 |
8 |
|
|
|
|
|
|
(4040-0014) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ACH Vendor/Miscellaneous Payment Enrollment Form |
SF-3881 |
9 |
1 |
9 |
0.25 |
3 |
|
|
|
|
|
|
(1530-0069) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request for Obligation of Funds |
RD 1940-1 |
9 |
1 |
9 |
0.25 |
3 |
|
|
|
|
|
|
(0570-0062) |
|
|
|
|
|
|
|
|
|
| RUS Form 36 (07-91) |
|
|
|
|
|
|
|
|
Page __2__ of __2__ |
|
|