| USDA - RUS |
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Title of Information Document |
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OMB No. |
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0570-0074 |
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| SUMMARY OF INFORMATION COLLECTION |
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Co-operative Agreements |
Date Prepared |
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Oct-21 |
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| INSTRUCTIONS: |
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> |
(f) TOTAL |
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(h) TOTAL |
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(k) TOTAL |
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| Use this form when a single information collection document involves multiple reporting and |
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> |
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= (e) Average |
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= (g) Average |
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= (j) Average |
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| recordkeeping requirements. |
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> |
(d) TOTAL |
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(f) TOTAL |
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(i) TOTAL |
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| IDENTIFICATION OF REPORTING AND RECORDKEEPPING REQUIREMENTS |
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ANNUAL BURDEN |
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FORM |
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REPORTS |
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RECORDS |
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NO(s) |
NO. OF |
NO. OF |
TOTAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
TOTAL |
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| SECTION OF |
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(If "none" |
RESPON- |
RESPONSES |
ANNUAL |
PER |
HOURS |
RECORD- |
HOURS PER |
RECORD- |
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| REGULATIONS |
DESCRIPTION |
so state) |
DENTS |
PER |
RESPONSES |
RESPONSE |
(Col. f & g) |
KEEPERS |
RECORD- |
KEEPING |
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RESPON- |
(Col. d & e) |
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KEEPER |
HOURS |
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DENT |
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(Col. i & j) |
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(b) |
(c) |
(d) |
(e) |
(f) |
(g) |
(h) |
(i) |
(j) |
(k) |
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Reporting Requirements – No Forms |
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Executive Summary |
Written |
100 |
1 |
100 |
2.00 |
200 |
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Work Plan |
Written |
100 |
1 |
100 |
3.00 |
300 |
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Organizational Capacity |
Written |
100 |
1 |
100 |
2.00 |
200 |
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Partnerships |
Written |
100 |
1 |
100 |
1.00 |
100 |
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Targeted Impact Area |
Written |
100 |
1 |
100 |
2.00 |
200 |
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Performance Measures |
Written |
100 |
1 |
100 |
2.00 |
200 |
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Verification of Matching Funds |
Written |
100 |
1 |
100 |
1.00 |
100 |
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Confilict of Interest Disclosure |
Written |
100 |
1 |
100 |
0.50 |
50 |
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Risk Review |
Written |
100 |
1 |
100 |
1.00 |
100 |
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Report Suitable for Public Distribution |
Written |
100 |
1 |
100 |
2.00 |
200 |
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SUBTOTAL |
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1,000 |
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1,650.00 |
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Reporting Requirements for Forms Approved under other OMB Numbers |
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Letter of Intent to Meet Conditions |
RD 1942-46 (0575-0015) |
100 |
1 |
100 |
1 |
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Request for Obligations of Funds |
1940-1 (0575-0067) |
100 |
1 |
100 |
0.25 |
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Assurance Agreement |
400-1 (0575-0018) |
100 |
1 |
100 |
0.25 |
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Equal Opportunity Agreement |
400-4 (0575-0018) |
100 |
1 |
100 |
0.16 |
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Application for Federal Assistance |
SF-424 (4040-0004) |
100 |
1 |
100 |
1.00 |
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Budget Information: Non-Construction Programs |
SF-424A (4040-0006 ) |
100 |
1 |
100 |
1.00 |
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Assurances - Non Construction Programs |
SF-424B (4040-0007) |
100 |
1 |
100 |
0.50 |
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Federal Financial Report |
SF-425 (4040-0014) |
100 |
4 |
400 |
1.00 |
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Request for Advance or Reimbursement |
SF-270 (4040-0012) |
100 |
On ocassion |
100 |
1.00 |
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Disclosure Form to Report Lobbying |
SF-LLL (4040-0013) |
100 |
1 |
100 |
0.16 |
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Certification Regarding Debarment, Suspension, and Other Responsibility Matters-Primary Covered Transactions |
AD-1047 (0505-0027) |
100 |
1 |
100 |
0.25 |
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Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion. Lower Tier Covered Transactions |
AD-1048 (0505-0027) |
100 |
1 |
100 |
0.25 |
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Certification Regarding Drug-Free Workplace Requirements (Grants).” |
AD-1049 (0505-0027) |
100 |
1 |
100 |
0.25 |
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Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants |
AD-3031 (0505-0025) |
100 |
1 |
100 |
0.25 |
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Subtotal |
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| RUS Form 36 (07-91) |
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Annual Burden Hours |
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1,650 |
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Record Keeping Hours |
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TOTAL ANNUAL BURDEN AND RECORDKEEPING HOURS |
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Total Burden Hours |
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1,650 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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Page __2__ of __3__ |
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