RD Co-op Agreements Spreadsheet

USDA - RUS		Title of Information Document						OMB No.
									0572-New
SUMMARY OF INFORMATION COLLECTION		Co-operative Agreements						Date Prepared
								Apr-21
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)
	Reporting Requirements – No Forms
	Executive Summary	Written	100	1	100	2.00	200
	Work Plan	Written	100	1	100	3.00	300
	Organizational Capacity	Written	100	1	100	2.00	200
	Partnerships	Written	100	1	100	1.00	100
	Targeted Impact Area	Written	100	1	100	2.00	200
	Performance Measures	Written	100	1	100	2.00	200
	Verification of Matching Funds	Written	100	1	100	1.00	100
	Confilict of Interest Disclosure	Written	100	1	100	0.50	50
	Risk Review	Written	100	1	100	1.00	100
	Report Suitable for Public Distribution	Written	100	1	100	2.00	200
	SUBTOTAL				1,000		1,650.00
	Reporting Requirements for Forms Approved under other OMB Numbers
	Letter of Intent to Meet Conditions	RD 1942-46 (0575-0015)	100	1	100	1
	Request for Obligations of Funds	1940-1 (0575-0067)	100	1	100	0.25
	Assurance Agreement	400-1 (0575-0018)	100	1	100	0.25
	Equal Opportunity Agreement	400-4 (0575-0018)	100	1	100	0.16
	Application for Federal Assistance	SF-424 (4040-0004)	100	1	100	1.00
	Budget Information: Non-Construction Programs	SF-424A (4040-0006 )	100	1	100	1.00
	Assurances - Non Construction Programs	SF-424B (4040-0007)	100	1	100	0.50
	Federal Financial Report	SF-425 (4040-0014)	100	4	400	1.00
	Request for Advance or Reimbursement	SF-270 (4040-0012)	100	On ocassion	100	1.00
	Disclosure Form to Report Lobbying	SF-LLL (4040-0013)	100	1	100	0.16
	Certification Regarding Debarment, Suspension, and Other Responsibility Matters-Primary Covered Transactions	AD-1047 (0505-0027)	100	1	100	0.25
	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion. Lower Tier Covered Transactions	AD-1048 (0505-0027)	100	1	100	0.25
	Certification Regarding Drug-Free Workplace Requirements (Grants).”	AD-1049 (0505-0027)	100	1	100	0.25
	Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants	AD-3031 (0505-0025)	100	1	100	0.25
	Subtotal
RUS Form 36 (07-91)
					Annual Burden Hours		1,650
					Record Keeping Hours
	TOTAL ANNUAL BURDEN AND RECORDKEEPING HOURS				Total Burden Hours		1,650
										0.00
										0.00
										0.00
										0.00
										0
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