Final- ReConnect Spreadsheet

USDA - RUS				Title of Information Document						OMB No.
				Rural e-Connectivity Pilot Program							0572-0152
SUMMARY OF INFORMATION COLLECTION				(ReConnect Program)						Date Prepared
											Oct-23
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
	(a)					DENT						(Col. i & j)
Grants	Combos	Loans	(b)	(c)	(d)	(e)	(f)	(g)	(h)	(i)	(j)	(k)
			Items Cleared Under This Docket
			Applicant Information
			Funding Request	Non-form	480	1	480	2.00
			Executive Summary	Non-form	480	1	480	4.00	1,920
			Legal Opinion	Non-form	480	1	480	2.00	960
			Organizational Charts	Non-form	480	1	480	1.00	480
			Resumes of Key Management Personnel	Non-form	480	1	480	1.00	480
			Broadband Operations Experience	Non-form	480	1	1,000	1.00	1,000
			Proposed Funded Service Area Description	Non-form	480	1	480	20.00	9,600
			Proposed Funded Service Area Map	Non-form	480	1	480	30.00	14,400
			Subscriber Projections	Non-form	480	1	480	10.00	4,800
			Competitive Analysis	Non-form	480	1	480	8.00	3,840
			Network Design	Non-form	480	1	480	40.00	19,200
			Licenses, Agreements, and Regulatory Approvals	Non-form	480	1	480	10.00	4,800
			Summary and Itemized Budgets	Non-form	480	1	480	20.00	9,600
			Pro Forma Financial Analysis	Non-form	480	1	480	60.00	28,800
			Sources of Other Funding	Non-form	480	1	480	2.00	960
	N/A	N/A	Matching Requirement (required for 100 percent grant request only)	Non-form	257	1	257	2.00	514
			List of Outstanding and Contingent Obligations	Non-form	480	1	480	2.00	960
			Historical Financial Statements	Non-form	480	1	480	2.00	960
			Audited Financial Statements	Non-form	480	1	480	2.00	960
			Evaluation Criteria	Non-form	480	1	480	20.00	9,600
			Environmental Information	Non-form	480	1	480	10.00	4,800
			State-funded Areas Certification	Non-form	480	1	480	2.00	960
			Certification of Investor Compliance	Non-form	480	1	480	1.00	480
N/A	N/A		Acquisition Agreement (applicable to 100 percent loan request only)	Non-form	32	1	32	3.00	96
			Certification of Tribal Support (if applicable)	Non-form	50	1	50	5.00	250
			Substantially Underserved Trust Area Application (if applicable)	Non-form	22	1	22	30.00	660
			Evidence of Legal Existence	Non-form	480	1	480	2.00	960
			Certificate Regarding Architectural Barriers	Non-form	480	1	480	1.00	480
			Certification Regarding Debarment, Suspension, and Other Responsibility Matters – Primary Covered Transactions	SBA Form 1623	480	1	480	1.00	480
			Certificate Regarding Flood Hazard Area Precautions	Non-form	480	1	480	1.00	480
			Certification Regarding Lobbying for Contracts, Grants, Loans and Cooperative Agreements		480	1	480	1.00	480
			Civil Rights Compliance Certification	Non-form	480	1	480	1.00	480
			Federal Collection Policies for Commercial Debt Certification	Non-form	480	1	480	1.00	480
			Lobbying Certification for Loan Guarantees and Loan Insurance	SF-LLL	480	1	480	1	480
			Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 Certification	Non-form	480	1	480	1.00	480
			Sam Registration, Certifications, Representations	Sam.gov	480	1	480	2	960
			Public Notice Filing Information
			Public Notice Responses	Non-form	480	3	6,000	1.50	9,000
			Recipient Information
			Updated Information for the Preparation of Legal Documents	Non-form	208	1	208	10.00	2,080
			Execution of Award Documents	Non-form	208	1	208	5.00	1,040
			Evidence of Fidelity Bond Coverage	Non-form	208	1	208	2.00	416
			Evidence of First Lien	Non-form	208	1	208	4.00	832
			Semiannual Performance Reports	Non-form	208	1	208	5.00	1,040
			Annual Audited Financial Statements.	Non-form	208	1	208	10.00	2,080
			Annual Service Area Maps and Progress Reports	Non-form	208	1	208	10.00	2,080
			Final Service Area Map and Accomplishments	Non-form	208	1	208	16.00	3,328
			Reporting and Compliance (R&C) Quarterly Reports	Non-form	208	4	832	2.00	1,664
			Total Burden Hours for form approved under this OMB docket 4040-0013
			Disclosure of Lobbying Activities (SF-LLL)	SF-LLL	480	1	480	1.00	480
Total burden hours for forms approved under this OMB Docket 0572-0152					480	51.54	24,737	6.12	151,360
			FORMS APPROVED UNDER OTHER OMB DOCKETS
			Forms approved under OMB Docket No.0505-0025
		5 U.S.C. 552(a), as amended	Representations Regarding Felony Conviction (AD 3030) - For Corporations Only	AD 3030	480	1	480	0.25	120
		5 U.S.C. 552(a), as amended	Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants (AD 3031)	AD 3031	480	1	480	0.05	24
			Forms approved under OMB Docket No. 0572-0059
			Construction Certification Program
			Engineering and Architectural Services
		1753	Postloan Engineering Service Contract	217	208	1	208	7.00	1,456
		Subpart B	● Approval of Postloan Engineering Service Contract
			The Postloan Eng. Serv. Contract incl. using the following forms:
			RUS Form 217a-Project Design, Assistance and Coordination:
			RUS Form 217b-Central Office Equipment Engineering Services;
			RUS Form 217c-Transmission Facilities Engineering Services;
			RUS Form 217d-Building Engineering Services;
			RUS Form 217e-Outside Plant Staking Services;
			RUS Form 217f-Outside Plant Contract Doc. Phase Engr. Servs.
			RUS Form 217g-Outside Plant Construction Phase Engr. Servs.
			RUS Form 216 - Construction Change Order	216	208	1	200	1.00	200
			RUS Form 526 – Construction Contract Amendment	526	208	1	200	3.00	600
			RUS Form 270 - Equal Opportunity Addendum	270	208	1	200	0.15	30
			Miscellaneous Engineering Services Forms
		1753.15,	Engineering Service Contract - Special Services - Telephone	245	208	1	208	0.75	156
		81	● Engineering services for minor construction may be
			contracted using Form 245 (This contract form does not
			require RUS approval).
		175349	Tabulation of Materials Furnished by Borrower
			● Closeout of major outside plans construction by contract.	281	208	4	832	2.00	1,664
		1753.8(b)	Subcontracts (Under Construction or Equipment)
			● Approval of subcontracts (per 1753.8(b))	282	208	2	416	0.75	312
		1753.16	Certificate of Architect
			● Approval of final statement of cost-architectural services	284	208	1	208	0.50	104
		1753.17	Statement of Engineering Fees - Telecommunications
			● Estimates	506	208	1	208	6.00	1,248
		1753.17	● Final		208	1	208	6.00	1,248
			Major Outside Plant Construction
			Telephone System Construction Contract (Labor and Materials)
		1753.47	● Approval of plans and specifications for major outside	515
			plant construction by contract		208	1	208	4.00	832
		1753.48	● Approval of the outside plant contract		208	1	208	6.00	1,248
		1753.48	● Owner-Furnished Materials -Info. Included under RUS Form 787 below
		1753.48	● Approval of negotiated contracts		208	1	208	2.00	416
			Miscellaneous Outside Plant Construction Forms
		1753.49	Final Inventory, Telephone Construction Contract
			(Labor and Materials)	724	208	2	416	0.75	312
			● Closeout of major outside plant construction by contract
		1753.49	Final Inventory, Telephone Construction Contract
			(Labor and Materials) - Detailed	724a	208	2	416	3.00	1,248
			● Tabulation of Assembly Units
		1753.49	Final Inventory, Telephone Construction Contract
			(Labor and Materials) - Detailed	724b	208	2	416	0.75	312
			● Removals
		1753.18	Contract Closeout Certification	756	208	1	208	0.50	104
		1753.81-82	Summary of Work Order
			Inspection by licensed Engineer or Borrower's Staff Engineer	771a	208	2	416	0.50	208
		1753	Miscellaneous Construction Work and Maintenance
			Service Contract	773
			● Issued for minor construction by contract		208	2	416	3.00	1,248
		1753.48 (f)	Supplement A to Construction Contract RUS Form 515	787	208	5	1040	0.25	260
			● Approval for the borrower to furnished materials for outside
			plant construction by contract
		1753.15	Preloan Engineering Service Contract, Telephone
		(a)(2)	System Design	835	208	1	208	0.75	156
			Forms approved under OMB Docket No. 0572-0149
		1753	Equipment Contract	395	208	2	416	1.50	624
		Subpart E, H
		1753.37, 38,	Certificate of Completion, Equipment Contract	395a	208	1	208	0.50	104
		39, 68	(Including Installation)
		1753.37, 38,	Certificate of Completion, Equipment Contract	395b	208	1	208	0.50	104
		39, 68	(Not Including Installation)
			Forms approved under OMB Docket No. 0572-0107
		1753, 1788	Contractor's Bond	168b	208	2	416	0.02	6.7
		1753.30	Certificate of Completion - Contract Construction for Building	181	208	1	208	0.10	21
			Closeout of Contract Form 257 for Building Construction.
		1753	Certificate ("Buy American")	213	208	1	0	0.02	0.0
			RUS Form 224 -Waiver and Release	224	208	1	200	0.01	2.0
			RUS Form 743 - Certificate of Contractor and Indemnity Agreement	743	208	1	200	0.01	2.0
		1753.30,	Certificate of Contractor	231	208	1	0	0.02	0.0
		39, 49
		1753.11,	Construction or Equipment Contract Amendment	238	208	2	0	0.02	0.0
		28, 38, 68
		1753	Contract to Construct Building	257	208	1	0	0.08	0.0
		Subpart D
			Bid Bond	307	208	2	0	0.02	0.0
			Form approved under OMB Docket No. 0572-0023
		1744.66	Financial Requirements Statement	481	208	3	624	2.00	1248
			Form approved under OMB Docket No. 0572-0074
		1744.66	Certification of Authority	675	208	2	416	0.10	42
			Form approved under OMB Docket No. 0572-0118
		Subpart B	Architectural Services Contract	220	208	1	208	1.00	208
		Subpart B
			Form approved under OMB Docket No. 0572-0095
		1773.4	Selection of CPA	n/a	208	1	208	0.25	52
			Miscellaneous Environmental Forms							240	29	6,960
		1970.53	CATEX with no report	n/a	240	1	240	80.00	19200
		1970.54	CATEX with report	n/a	61	1	61	640.00	39040
		1970.101	Environmental Assessment	n/a	3	1	3	1852.00	5556				*Per CFR EA can take no longer than a year and no longer than 2 years for EIS
		1970.151	Environmental Impact Statement	n/a	0	1	14022	0.00	0
		Total burden hours for forms approved under other OMB Dockets			240	58	14,022	5.67	79,571.1	208		6,960
											Page __1__ of __1__
							Annual Burden Hours		151,360
							Record Keeping Hours		6,960
			TOTAL ANNUAL BURDEN AND RECORDKEEPING HOURS				Total Burden Hours		158,320
RUS Form 36 (07-91)