Document Name Document Type
Application for Rural Libraries, Technical Assistance, and Satellite Grants Form
Technical Assistance Application Form BIP TA Grant Application Form.doc www.broadbandusda.gov Form
Satellite Application Form General Application Information Form.doc www.broadbandusa.gov Form
Rural Library Application Form Rural Library App.docx www.broadbandusa.gov Form
BIP TA Prgm App Guide.docx BIP TA Program Application Guide IC Document
Rural Library Broadband Application Guide.doc Rural Library Application Guide IC Document
Library Attachment A - Additional Co-Applicant Information.doc Rural Library Attachment A IC Document
Library Attachment C - Listing of Rural Libraries.xls Rural Library Attachment C IC Document
Library Attachment D - Certification Regarding Availability of Broadband Service and Community Facilities Funding.docx Rural Library Attachment D IC Document
Library Attachment E - Detailed Project Budget.xls Rural Library Attachment E IC Document
Library Attachment G - Environmental Questionnaire.doc Rural Library Attachment G IC Document
Library Attachment H - Equal Opportunity and Nondiscrimination Certification.pdf Rural Library Attachment H IC Document
Library Attachment B - Executive Summary.doc Rural Library Attachment B IC Document
Library Attachment F - Project Buildout Timeline & Key Milestones.xls Rural Library Attachment F IC Document
Library Attachment K - Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions.pdf Rural Library Attachment K IC Document
Library Attachment I - Certification Regarding Architectural Barriers.pdf Rural Library Attachment I IC Document
Library Attachment J - Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 Certification.pdf Rural Library Attachment J IC Document
TA Attachment A - Additional Co-Applicant Information.doc TA Attachment A IC Document
TA Attachment B - Detailed Project Budget.xls TA Attachment B IC Document
TA Attachment C - Project Timeline & Key Milestones.xls TA Attachment C IC Document
TA Attachment D - Equal Opportunity and Nondiscrimination Certification.pdf TA Attachment D IC Document
TA Attachment E - Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions.pdf TA Attachment E IC Document
TA Attachment F - Certification Regarding Lobbying for Contracts, Grants, Loans, and Cooperative Agreements.pdf TA Attachment F IC Document
Satellite Attachment A - Additional Co-Applicant Information.doc Satellilte Attachment A IC Document
Satellite Attachment B - Executive Summary.doc Satellite Attachment B IC Document
Satellite Attachment C - Service Provisions.doc Satellite Attachment C IC Document
Satellite Attachment D - Service Offerings.xls Satellite Attachment D IC Document
Satellite Attachment F - Organizatinoal Readiness.doc Satellite Attachment F IC Document
Satellite Attachment E - Management Team Resumes.doc Satellite Attachment E IC Document
Satellite Attachment G � Organizational Chart.doc Satellite Attachment G IC Document
Satellite Attachment H - Subscriber Projections.xls Satellite Attachment H IC Document
Satellite Attachment I - Pro Forma 5-Year Financial Forecast.xls Satellite Attachment I IC Document
Satellite Attachment J � Commitment of Capital Funding Support.doc Satellite Attachment J IC Document
Satellite Attachment K - Schedule of Debt and Equity Funding.xls Satellite Attachment K IC Document
Satellite Attachment L - Service Metrics.doc Satellite Attachment L IC Document
Satellite Attachment M - Project Build-Out Timeline and Key Milestones.xls Satellite Attachment M IC Document
Satellite Attachment N - Equal Opportunity and Nondiscrimination Certification.pdf Satellite Attachment N IC Document
Satellite Attachment O - Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions.pdf Satellite Attachment O IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Rural Libraries, Technical Assistance, and Satellite Grants	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	n/a	Technical Assistance Application Form	BIP TA Grant Application Form.doc	www.broadbandusda.gov	Yes	No	Fillable Printable
Form	n/a	Satellite Application Form	General Application Information Form.doc	www.broadbandusa.gov	Yes	No	Fillable Printable
Form	n/a	Rural Library Application Form	Rural Library App.docx	www.broadbandusa.gov	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 134	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	374	374
Annual IC Time Burden (Hours)	8,427	8,427
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
BIP TA Program Application Guide	BIP TA Prgm App Guide.docx	04/19/2010
Rural Library Application Guide	Rural Library Broadband Application Guide.doc	04/19/2010
Rural Library Attachment A	Library Attachment A - Additional Co-Applicant Information.doc	04/19/2010
Rural Library Attachment C	Library Attachment C - Listing of Rural Libraries.xls	04/19/2010
Rural Library Attachment D	Library Attachment D - Certification Regarding Availability of Broadband Service and Community Facilities Funding.docx	04/19/2010
Rural Library Attachment E	Library Attachment E - Detailed Project Budget.xls	04/19/2010
Rural Library Attachment G	Library Attachment G - Environmental Questionnaire.doc	04/19/2010
Rural Library Attachment H	Library Attachment H - Equal Opportunity and Nondiscrimination Certification.pdf	04/19/2010
Rural Library Attachment B	Library Attachment B - Executive Summary.doc	04/19/2010
Rural Library Attachment F	Library Attachment F - Project Buildout Timeline & Key Milestones.xls	04/19/2010
Rural Library Attachment K	Library Attachment K - Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions.pdf	04/19/2010
Rural Library Attachment I	Library Attachment I - Certification Regarding Architectural Barriers.pdf	04/19/2010
Rural Library Attachment J	Library Attachment J - Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 Certification.pdf	04/19/2010
TA Attachment A	TA Attachment A - Additional Co-Applicant Information.doc	04/19/2010
TA Attachment B	TA Attachment B - Detailed Project Budget.xls	04/19/2010
TA Attachment C	TA Attachment C - Project Timeline & Key Milestones.xls	04/19/2010
TA Attachment D	TA Attachment D - Equal Opportunity and Nondiscrimination Certification.pdf	04/19/2010
TA Attachment E	TA Attachment E - Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions.pdf	04/19/2010
TA Attachment F	TA Attachment F - Certification Regarding Lobbying for Contracts, Grants, Loans, and Cooperative Agreements.pdf	04/19/2010
Satellilte Attachment A	Satellite Attachment A - Additional Co-Applicant Information.doc	04/19/2010
Satellite Attachment B	Satellite Attachment B - Executive Summary.doc	04/19/2010
Satellite Attachment C	Satellite Attachment C - Service Provisions.doc	04/19/2010
Satellite Attachment D	Satellite Attachment D - Service Offerings.xls	04/19/2010
Satellite Attachment F	Satellite Attachment F - Organizatinoal Readiness.doc	04/19/2010
Satellite Attachment E	Satellite Attachment E - Management Team Resumes.doc	04/19/2010
Satellite Attachment G	Satellite Attachment G � Organizational Chart.doc	04/19/2010
Satellite Attachment H	Satellite Attachment H - Subscriber Projections.xls	04/19/2010
Satellite Attachment I	Satellite Attachment I - Pro Forma 5-Year Financial Forecast.xls	04/19/2010
Satellite Attachment J	Satellite Attachment J � Commitment of Capital Funding Support.doc	04/19/2010
Satellite Attachment K	Satellite Attachment K - Schedule of Debt and Equity Funding.xls	04/19/2010
Satellite Attachment L	Satellite Attachment L - Service Metrics.doc	04/19/2010
Satellite Attachment M	Satellite Attachment M - Project Build-Out Timeline and Key Milestones.xls	04/19/2010
Satellite Attachment N	Satellite Attachment N - Equal Opportunity and Nondiscrimination Certification.pdf	04/19/2010
Satellite Attachment O	Satellite Attachment O - Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions.pdf	04/19/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

Application for Rural Libraries, Technical Assistance, and Satellite Grants

Broadband Initiatives Program - Rural Libraries, Technical Assistance, and Satellite Grants

OMB: 0572-0145

IC ID: 192612

View Information Collection (IC)