Spreadsheet for 7 CFR 1783

USDA - RUS		Title of Information Document						OMB No.
									0572-0139
SUMMARY OF INFORMATION COLLECTION		7 CFR 1776 Household Water System Program						Date Prepared
									Sep-07
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
7 CFR Part1776.7(c)	Statement of Experience	Written	10	1	10	4.00	40.00
Application Guide	Project Proposal	Written	10	1	10	40.00	400.00
7 CFR Part 1776.7(b)	Work Plan (scope of work)	Written	10	1	10	5.00	50.00
Application Guide	Budget Justification	Written	10	1	10	1.00	10.00
7 CFR Part 1776.7(d)	Prior year Audit / Financial Statement	Written	10	1	10	3.00	30.00
7 CFR Part 1776.9(d)	Pro-forma Balance Sheet and Financial Statements	Written	10	1	10	10.00	100.00
Application Guide	Organizational Documents-Evidence of Legal Existence and Authority	Written	10	1	10	0.25	2.50
Application Guide	List of Directors and Officers	Written	10	1	10	0.25	2.50
Application Guide	Evidence of Tax Exempt Status	Written	10	1	10	0.25	2.50
RD Instruction 1900-D	Identify Employee Relationship	Written	10	1	10	0.17	1.70
7 CFR Part 3018.110 & Application Guide	Certification Regarding Lobbying	Written	10	1	10	0.17	1.70
7 CFR Part 3017.335 & Application Guide	Debarment and Suspension Information	Written	10	1	10	0.25	2.50
7 CFR Part 3021.230 & Application Guide	Drug-Free Workplace Requirements	Written	10	1	10	0.25	2.50
Executive Order 13166	Limited English Proficiency	Written	10	1	10	1.50	15.00
7 CFR Part 1776.1	Grant Agreement	Written	5	1	5	2.00	10.00
7 CFR Part 3019.26 and 7 CFR Part 3052	Annual Audit / Financial Statement	Written	5	1	5	40.00	200.00
7 CFR Part 3019.25	Request written approval of workplan changes	Written	5	1	5	0.25	1.25
7 CFR Part 3019.51	Project Performance Report	Written	5	4	20	12	240
	Total Items Cleared Under This Package		10		175.00		1,112.15
	Items Cleared Under Other Packages
7 CFR Part 1776.9(a)(1)	Application for Federal Assistance	SF-424	10	1	10	0.75	7.50
		(0348-0043 &
		4040-0004)
7 CFR Part 1776.9(a)(2)	Budget Information	SF-424A	10	1	10	3.00	30.00
		(0348-0044&
		4040-0006)
7 CFR Part 1776.9(a)(3)	Assurances - Non Construction Programs	SF-424B	10	1	10	0.25	2.50
		(0348-0040 &
		4040-0007)
7 CFR Part 3018.110 & Application Guide	Disclosure of Lobbying Activities	SF-LLL	5	1	5	0.17	0.85
		(0348-0038)
Application Guide	Equal Opportunity Agreement	RD 400-1	5	1	5	0.17	0.85
		(0575-0018)
Application Guide	Assurance Agreement	RD 400-4	5	1	5	0.25	1.25
		(0575-0018)
7 CFR Part 3019.22	Request for Advance or Reimbursement	SF 270	5	12	60	1.00	60.00
		(0348-0004)
7 CFR Part 3019.52	Financial Status Report (Short Form)	SF 269A	37	4	148	1.50	222.00
		(0348-0038)