Summary Burden Spreadsheet

USDA - RUS		Title of Information Document						OMB No.
		New Form 395 - Equipment Contract for Telecommunications							0572-NEW
SUMMARY OF INFORMATION COLLECTION		and Broadband Borrowers						Date Prepared
								2014
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 RECORDKEEPING 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)
1753	Equipment Contract	395	279	1	279	1.50	418.50
Subpart E, H
1753.3 and 6	Borrower's non-conformance request letter	Written	5	1	5	1.00	5.00
Subpart A	(construction, design, materials, equipment, etc..)
1753.37, 38,	Certificate of Completion, Equipment Contract	395a	211	1	211	0.50	105.50
39, 68	(Including Installation)
1753.37, 38,	Certificate of Completion, Equipment Contract	395b	68	1	68	0.50	34.00
39, 68	(Not Including Installation)
1753.37, 38,	Certificate of Contractor and Indemnity Agreement	395c	211	1	211	0.50	105.50
39, 68	(Use only for installation contracts)
1753.37, 38,	Report in writing, including all measurements, any	395d	211	1	211	0.75	158.25
39, 68	acceptance test report and other information required under
	Part II of applicable specifications
1753	Certification Regarding Debarment, Suspension, Ineligibility	AD1048	211	1	211	0.25	52.75
Subpart E, H	and Voluntary Exclusion - Lower Tier Covered Transactions
1753	Lobbying Certification (Telephone Version 3, 8/11)	Written	211	1	211	0.05	10.55
Subpart E, H
	TOTALS				1,407		890.00
	FORMS APPROVED UNDER OTHER OMB NUMBERS
1753	Certificate ("Buy American")	213	279	1	279	0.016	4.46
		0572-0107
1753.11,	Construction or Equipment Contract Amendment	238	10	1	10	0.016	0.16
28, 38, 68		0572-0107
1784.20(b)(7)	Disclosure of Lobbying Acitivities	SF LLL	1	1	1	0.25	0.25
		(0348-0046)
	Total burden associated with OTHER packages		279	1.00	290	0.02	5			Page 2
	Total burden hours associated with THIS package				1,407		890
	COMBINED burden associated with this package				1,697		895