Document Name Document Type
Form 532 Rural Broadband Access Loan & Loan Guarantee Application Form
532 Rural Broadband Access Loan and Loan Guarantee Applicati broadband-application532-2.doc www.rurdev.usda.gov/utp_farmbill.html Form
Broadband Application Guide 11 16 10.docx Application Guide IC Document
Schedule C-1 - Legal Opinion.docm Schedule C-1 IC Document
Schedule C-2 - Real Property Schedule.docm Schedule C-2 IC Document
Schedule F-2 - Service Area Demographic Data.docm Schedule F-2 IC Document
Schedule H-1 - Equal Opportunity and Non Discrimination.docm Schedule H-1 IC Document
Schedule H-2 - Certification Regarding Architectural Barriers.docm Schedule H-2 IC Document
Schedule H-3 - Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.docm Schedule H-3 IC Document
Schedule H-4 - Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions.docm Schedule H-4 IC Document
Schedule H-5 - Certification Regarding Lobbying for Contracts, Grants, Loans, and Cooperative Agreements.docm Schedule H-5 IC Document
Schedule H-6 - Certifcate Regarding Flood Hazard Area Precautions.docm Schedule H-6 IC Document
Schedule I - Outstanding Federal Debt.docm Schedule I IC Document
Schedule J-1 - Investor Proposal.docm Schedule J-1 IC Document
Schedule J-2 - Equity State or Local Govt Bond.docm Schedule J-2 IC Document
Schedule L-1 - Competitive Analysis.docm Schedule L-1 IC Document
Schedule M-2 - Schedule of Debt and Equity Funding.xls Schedule M-2 IC Document
Schedule M-3 - Subscriber Projections and Service Tiers3.xls Schedule M-3 IC Document
Schedule M-4A - Pro Forma 5-Year Financial Forecast.xls Schedule M-4A IC Document
Schedule M-5 - Additional Cash.pdf Schedule M-5 IC Document
Schedule M-6 - Depreciation Schedule.xls Schedule M-6 IC Document
Schedule N-2 - Service Metrics and Network Management.doc Schedule N-2 IC Document
Schedule N-3 Network Design Certification.doc Schedule N-3 IC Document
Schedule P- Project Capital Investment Workbook.xls Schedule P IC Document
Schedule R- Licenses and Agreements.xls Schedule R IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rural Broadband Access Loan & Loan Guarantee Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 1738

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	532	Rural Broadband Access Loan and Loan Guarantee Application	broadband-application532-2.doc	http://www.rurdev.usda.gov/utp_farmbill.html	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: 25	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	118	93	-15	40
Annual IC Time Burden (Hours)	10,545	545	-3,000	13,000
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Application Guide	Broadband Application Guide 11 16 10.docx	12/17/2010
Schedule C-1	Schedule C-1 - Legal Opinion.docm	12/17/2010
Schedule C-2	Schedule C-2 - Real Property Schedule.docm	12/17/2010
Schedule F-2	Schedule F-2 - Service Area Demographic Data.docm	12/17/2010
Schedule H-1	Schedule H-1 - Equal Opportunity and Non Discrimination.docm	12/17/2010
Schedule H-2	Schedule H-2 - Certification Regarding Architectural Barriers.docm	12/17/2010
Schedule H-3	Schedule H-3 - Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.docm	12/17/2010
Schedule H-4	Schedule H-4 - Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions.docm	12/17/2010
Schedule H-5	Schedule H-5 - Certification Regarding Lobbying for Contracts, Grants, Loans, and Cooperative Agreements.docm	12/17/2010
Schedule H-6	Schedule H-6 - Certifcate Regarding Flood Hazard Area Precautions.docm	12/17/2010
Schedule I	Schedule I - Outstanding Federal Debt.docm	12/17/2010
Schedule J-1	Schedule J-1 - Investor Proposal.docm	12/17/2010
Schedule J-2	Schedule J-2 - Equity State or Local Govt Bond.docm	12/17/2010
Schedule L-1	Schedule L-1 - Competitive Analysis.docm	12/17/2010
Schedule M-2	Schedule M-2 - Schedule of Debt and Equity Funding.xls	12/17/2010
Schedule M-3	Schedule M-3 - Subscriber Projections and Service Tiers3.xls	12/17/2010
Schedule M-4A	Schedule M-4A - Pro Forma 5-Year Financial Forecast.xls	12/17/2010
Schedule M-5	Schedule M-5 - Additional Cash.pdf	12/17/2010
Schedule M-6	Schedule M-6 - Depreciation Schedule.xls	12/17/2010
Schedule N-2	Schedule N-2 - Service Metrics and Network Management.doc	12/17/2010
Schedule N-3	Schedule N-3 Network Design Certification.doc	12/17/2010
Schedule P	Schedule P- Project Capital Investment Workbook.xls	12/17/2010
Schedule R	Schedule R- Licenses and Agreements.xls	12/17/2010

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

Rural Broadband Access Loan & Loan Guarantee Application

7 CFR 1738, Rural Broadband Loan and Loan Guarantee Program

OMB: 0572-0130

IC ID: 1872

View Information Collection (IC)