Information Collection

Rural Energy Savings Program (RESP)

IC 221266 under ICR 201609-0572-002 · OMB 0572-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0151 can be found here:

Documents and Forms

Document Name Document Type
Form RUS Form 266 Rural Energy Savings Program (RESP) Form
RUS Form 266 Compliance Assurance RUS266.PDF forms.sc.egov.usda.gov/efcommon/eFileServices/eForms/RUS266.PDF Form
SF 100 EEO-1 Employer Information Report eeo1-2.pdf www.eeoc.gov/employers/eeo1survey/index.cfm Form
AD-1047 Certification Regarding Debarment, Suspension, and other AD-1047 (Dec '15).pdf www.ocio.usda.gov/sites/default/files/docs/2012/AD-1047 %28Dec %2715%29.pdf Form and Instruction
AD-1048 Certification Regarding Debarment, Suspension, Ineligibi AD-1048 (Dec '15).pdf www.ocio.usda.gov/sites/default/files/docs/2012/AD-1048 %28Dec %2715%29.pdf Form and Instruction
AD-1049 Certificate Regarding Drug-Free Workplace Requirements AD-1049 (Dec '15).pdf www.ocio.usda.gov/sites/default/files/docs/2012/AD-1049 %28Dec %2715%29.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rural Energy Savings Program (RESP)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	RUS Form 266	Compliance Assurance	RUS266.PDF	http://forms.sc.egov.usda.gov/efcommon/eFileServices/eForms/RUS266.PDF	Yes	No	Fillable Printable
Form	SF 100	EEO-1 Employer Information Report	eeo1-2.pdf	https://www.eeoc.gov/employers/eeo1survey/index.cfm	Yes	Yes	Fillable Fileable
Form and Instruction	AD-1047	Certification Regarding Debarment, Suspension, and other Responsibility Matters (Primary Covered Transactions)	AD-1047 (Dec '15).pdf	http://www.ocio.usda.gov/sites/default/files/docs/2012/AD-1047 %28Dec %2715%29.pdf	Yes	No	Fillable Printable
Form and Instruction	AD-1048	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion (Lower Tier Covered Transactions)	AD-1048 (Dec '15).pdf	http://www.ocio.usda.gov/sites/default/files/docs/2012/AD-1048 %28Dec %2715%29.pdf	Yes	No	Fillable Printable
Form and Instruction	AD-1049	Certificate Regarding Drug-Free Workplace Requirements	AD-1049 (Dec '15).pdf	http://www.ocio.usda.gov/sites/default/files/docs/2012/AD-1049 %28Dec %2715%29.pdf	Yes	No	Fillable Printable

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 33	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	225	13	212
Annual IC Time Burden (Hours)	1,422	68	1,354
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.