| USDA - RUS |
|
Assistance to High Energy Cost Rural Communities |
OMB No. |
|
|
|
|
|
0572-0136 |
|
| SUMMARY OF INFORMATION COLLECTION |
|
Date Prepared |
|
|
|
|
05/11/21 |
|
|
| INSTRUCTIONS: |
|
|
> |
|
|
(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. |
|
|
> |
|
|
(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 |
|
|
|
|
RESPOND- |
(Col. d & e) |
|
|
|
KEEPER |
HOURS |
|
|
|
|
DENT |
|
|
|
|
|
(Col. i & j) |
| (a) |
(b) |
(c) |
(d) |
e |
(f) |
(g) |
(h) |
(i) |
(j) |
(k) |
|
ITEMS APPROVED UNDER THIS COLLECTION |
|
|
|
|
|
|
|
|
|
|
Narrative Grant Proposal Application |
Non-Form |
60 |
1.00 |
60 |
10 |
600.00 |
|
|
|
|
RUS Environmental Profile |
Non-Form |
60 |
1.00 |
60 |
1 |
60.00 |
|
|
|
|
Grant Award and Post Award (Selected from 60 applicant respondents) |
|
|
|
|
|
|
|
|
|
|
Grant Agreement |
Non-Form |
12 |
1.00 |
12 |
1 |
12.00 |
|
|
|
| |
Performance Reports |
Non-Form |
40 |
4.00 |
160 |
2 |
320.00 |
|
|
|
| |
Final Performance Report |
Non-Form |
12 |
1.00 |
12 |
5.0 |
60.00 |
|
|
|
| |
Recordkeeping Requirements |
Non-Form |
|
|
|
|
|
40 |
3 |
120 |
|
Subtotal this Collection |
|
|
|
304 |
|
1,052 |
40 |
|
120 |
|
TOTALS |
|
|
|
344 |
|
1,172 |
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
FORMS APPROVED UNDER OTHER COLLECTIONS |
|
|
|
|
|
|
|
|
|
|
Application for Federal Assistance (4040-0004) |
SF-424 |
60 |
1.00 |
60 |
0.75 |
45.00 |
|
|
|
|
Budget Information Non-Construction Programs (4040-0006) |
SF-424A |
60 |
1.00 |
60 |
1 |
60.00 |
|
|
|
|
OR Budget Information Construction Programs (4040-0008) |
SF-424C |
|
|
|
|
|
|
|
|
|
Assurances Non-Construction Programs (4040-0009) |
SF-424B |
60 |
1.00 |
60 |
0.25 |
15 |
|
|
|
|
OR Assurances Construction Programs (4040-0009) |
SF-424D |
|
|
|
|
|
|
|
|
|
Representations Re: Felony Conviction (0505-0025) |
AD-3030 |
60 |
1.00 |
60 |
0.50 |
30.00 |
|
|
|
|
Assurances Re: Felony Conviction and Tax Delinquency |
AD-3031 |
12 |
1.00 |
12 |
0.50 |
6.00 |
|
|
|
|
Letter of Intent (0575-0015) |
RD 1942-46 |
12 |
1.00 |
12 |
1.00 |
12.00 |
|
|
|
|
Disclosure of Lobbying Activities (4040-0013) |
SF-LLL |
60 |
1.00 |
60 |
0.25 |
15.00 |
|
|
|
|
Post Award: |
|
|
|
|
|
|
|
|
|
|
Federal Financial Report (4040-0014) |
SF-425 |
40 |
4.00 |
160 |
1.50 |
240.00 |
|
|
|
|
Request for Reimbursement or Advance of Funds (4040-0012) |
SF-270 |
2 |
4.00 |
8 |
1.00 |
8.00 |
|
|
|
|
Outlay Report and Request for Reimbursement (Const.) (4040-0011) |
SF-271 |
38 |
4.00 |
152 |
1 |
152.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| RUS Form 36 (07-91) |
|
|
|
|
|
|
|
|
|
|