| USDA - RUS |
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Title of Information Document |
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OMB No. |
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0572-0110 |
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| SUMMARY OF INFORMATION COLLECTION |
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7 CFR 1778 Emergency and Imminent Community Water |
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Date Prepared |
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Assistance Grants |
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Aug-22 |
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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 |
| 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 |
| SECTION OF |
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(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 |
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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) |
| (a) |
(b) |
(c) |
(d) |
(e) |
(f) |
(g) |
(h) |
(i) |
(j) |
(k) |
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| 2 CFR 200 |
SAM Registration, Certifications and Representations |
Sam.gov |
9 |
1 |
9 |
2 |
18.00 |
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| 1778.1 (a) |
Relationship or association with RUS employees |
written |
49 |
1 |
49 |
0.25 |
12.25 |
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| 1778.6 (b) |
Evidence that imminent threat is likely to occur within one year; or, that a significant event occurred within 2 years |
written |
49 |
1 |
49 |
2.00 |
98.00 |
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| 1778.6 & |
Supporting Documentation (organizational, etc.) |
written |
49 |
1 |
49 |
4.00 |
196.00 |
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| 1778.7 |
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| 1778.7 & |
Documentation of Income Survey |
written |
10 |
1 |
10 |
8.00 |
80.00 |
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| 1778.10 (a) (2) |
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| 1778.14 (b) |
Environmental Report |
written |
49 |
1 |
49 |
24.00 |
1,176.00 |
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| 1778.14 (f) |
Intergovernmental comments |
written |
10 |
1 |
10 |
1.00 |
10.00 |
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| 1778.14 (g) |
Cert. for Contracts, Grants, and Loans (Regarding Lobbying) |
RD 1940-Q |
49 |
1 |
49 |
0.25 |
12.25 |
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| 1778.21 (a) |
Preliminary engineering report |
written |
49 |
1 |
49 |
24.00 |
1,176.00 |
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| 1778.22 |
Cert. from the State agency or the EPA confirming conformance with SWDA |
written |
49 |
1 |
49 |
2.00 |
98.00 |
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| 1778.31 |
Audits or Finanicial Statements |
Written |
37 |
1 |
37 |
8.00 |
296.00 |
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SUBTOTAL |
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409 |
11 |
409 |
6.86 |
3,173 |
0.00 |
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0.00 |
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TOTAL OF ALL PAGES |
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409 |
11 |
409 |
6.86 |
3,173 |
0 |
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0 |
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FORMS APPROVED UNDER OTHER OMB NUMBERS |
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| 1778.14 (a) |
Initial Compliance Review |
RD 400-8 |
49 |
1 |
49 |
8.00 |
392.00 |
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(0575-0018) |
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| 1778.14 (e ) & 1778.14 (i) |
SAM Registration (includes Debarment, Drug-free workplace, Representations Regarding Felony and Assurance Regarding Felony Conviction) |
Sam.gov |
49 |
1 |
49 |
2.25 |
110.25 |
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| 1778.23 (b) |
Grant Agreement |
RUS Bulletin 1780-12 |
43 |
1 |
43 |
1.00 |
43.00 |
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SUBTOTAL |
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141 |
3 |
141 |
3.75 |
545 |
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Total of all Pages |
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141 |
3 |
141 |
3.75 |
545 |
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| RUS Form 36 (07-91) |
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