2024 - 0572-0157_TAC-RWTS Spreadsheet(Form 36)_vsn 4_4.3.24

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__