Information Collection

Telecommunications System Construction Policies and Procedures

IC 1786 under ICR 201706-0572-002 · OMB 0572-0059.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0572-0059 can be found here:

Documents and Forms

Document Name Document Type
Form 375 Telecommunications System Construction Policies and Procedures Form
157 Construction Work Plan & Cost Distribution UTP_form_157.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
158 Certification of Contractor or Force Account Proposal Ap RUS158.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
159 Summary of Completed Construction RUS159.pdf http:/www.usda.gov/rus/telecom/publications/forms.htm Form
179 Architects and Engineers Qualifications UTP_form_179.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
216 Construction and Change Order UTP_form_216.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
217 Postloan Engineering Services Contract-Telecommunication UTP_form_217.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
242 Assignment of Engineering Service Contract UTP_form_242.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
245 Engineering Service Contract, Special Services-Telephone UTP_form_245.pdf www.usda.gov.rus/telecom/publications/forms.htm Form
270 Equal Opportunity Addendum UTP_form_270.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
274 Bidder's Qualifications UTP_form_274.pdf www.usda.gov/rus/teledom/publications/forms.htm Form
276 Bidder's Qualifications for Buried Plant Construction UTP_form_276.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
281 Tabulation of Materials Furnished by Borrower UTP_form_281.pdf www.usda.gov/rus/telecom/publicationsforms.htm Form
282 Subcontracts-(Under Construction or Equipment Contracts UTP_form_282.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
284 Certificate of Architect UTP_form_284.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
375 Interim Financing Construction UTP_form_375.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
390 Software License Agreement UTP_form_390.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
506 Statement of Engineering Fees- Telecommunications UTP_form_506.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
515 Telephone System Construction Contract(Labor & Materials UTP_form_515.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
521 BiWeekly Progress Report of Telephone Construciton & Eng UTP_form_521.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
527 Statement of Construction Telephone System-Outside Plant UTP_form_527.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
724 FInal Inventroy, Telephone Construction Contract (Labor& UTP_form_724.pdf htpp://www.usda.gov/rus/telecom/publications/forms.htm Form
724a Final Inventory, Telephone Construction Cpmtract (Labor UTP_form_724a.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
724b Final Inventory, Telephone Construction Contract (Labor UTP_form_724b.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
743 Certificate of Contractor & Indemnity Agreement (Line Ex UTP_form_743.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
756 Contract Closeout Certification UTP_form_756.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
771 Summary of Work orders (Inspection by Agency Field Engin RUS771.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
787 Supplement A to Construction Contract RUS Form 515 RUS-787.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
817 Final Inventory, Telephone Force Account Construction UTP_form_817.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
817a Final Inventory, Telephone Force Account Construction UTP_form_817a.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
817b Final Inventory, Telephone Force Account Construction UTP_form_817b.pdf www.usda.gov/rus/telecom/publications.forms.htm Form
835 Preloan Engineering Service Contract, Telephone System D UTP_form_835.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
771a Summary of Work Orders rus-771a.pdf www.usda..gov/rus/telecom/publications/forms.htm Form
Form 773 Miscellaneous Construction Work and Maintenance Services RUS-773.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
397b Design Specifications for Trunk Carrier Systems UTP_form_397b.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
397c Design Specification for Subscriber Carrier Systems UTP_form_397c.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
397d Design Specifications for Point to Point Microwave Radio UTP_form_397d.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
397g RUS Performance Specification for Line Concentrators UTP_form_397g.pdf www.usda.gov/rus/telecom/publications/forms.htm Form
397h Design Specifications for Digital Lightwave Tranmission UTP_form_397h.pdf www.usda.gov/rus/telecom/publications/forms.htm Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Telecommunications System Construction Policies and Procedures	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 7 CFR 1753

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	375	Interim Financing Construction	UTP_form_375.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	390	Software License Agreement	UTP_form_390.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	506	Statement of Engineering Fees- Telecommunications	UTP_form_506.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	515	Telephone System Construction Contract(Labor & Materials)	UTP_form_515.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	521	BiWeekly Progress Report of Telephone Construciton & Engineering Services	UTP_form_521.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	527	Statement of Construction Telephone System-Outside Plant	UTP_form_527.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	724	FInal Inventroy, Telephone Construction Contract (Labor& Materials)	UTP_form_724.pdf	htpp://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	724a	Final Inventory, Telephone Construction Cpmtract (Labor & Material)	UTP_form_724a.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	724b	Final Inventory, Telephone Construction Contract (Labor & Material)	UTP_form_724b.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	743	Certificate of Contractor & Indemnity Agreement (Line Extensions)	UTP_form_743.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	756	Contract Closeout Certification	UTP_form_756.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	771	Summary of Work orders (Inspection by Agency Field Engineer)	RUS771.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Paper Only
Form	787	Supplement A to Construction Contract RUS Form 515	RUS-787.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	817	Final Inventory, Telephone Force Account Construction	UTP_form_817.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	817a	Final Inventory, Telephone Force Account Construction	UTP_form_817a.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	817b	Final Inventory, Telephone Force Account Construction	UTP_form_817b.pdf	http://www.usda.gov/rus/telecom/publications.forms.htm	Yes	No	Printable Only
Form	835	Preloan Engineering Service Contract, Telephone System Design	UTP_form_835.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	157	Construction Work Plan & Cost Distribution	UTP_form_157.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	158	Certification of Contractor or Force Account Proposal Approval	RUS158.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Paper Only
Form	159	Summary of Completed Construction	RUS159.pdf	http:/www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	179	Architects and Engineers Qualifications	UTP_form_179.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	216	Construction and Change Order	UTP_form_216.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Paper Only
Form	217	Postloan Engineering Services Contract-Telecommunications Systems	UTP_form_217.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Paper Only
Form	242	Assignment of Engineering Service Contract	UTP_form_242.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	245	Engineering Service Contract, Special Services-Telephone	UTP_form_245.pdf	http://www.usda.gov.rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	270	Equal Opportunity Addendum	UTP_form_270.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	274	Bidder's Qualifications	UTP_form_274.pdf	http://www.usda.gov/rus/teledom/publications/forms.htm	Yes	No	Printable Only
Form	276	Bidder's Qualifications for Buried Plant Construction	UTP_form_276.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	281	Tabulation of Materials Furnished by Borrower	UTP_form_281.pdf	http://www.usda.gov/rus/telecom/publicationsforms.htm	Yes	No	Printable Only
Form	282	Subcontracts-(Under Construction or Equipment Contracts	UTP_form_282.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	284	Certificate of Architect	UTP_form_284.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	771a	Summary of Work Orders	rus-771a.pdf	http://www.usda..gov/rus/telecom/publications/forms.htm	Yes	No	Fillable Printable
Form	Form 773	Miscellaneous Construction Work and Maintenance Services Contract	RUS-773.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Fillable Printable
Form	397b	Design Specifications for Trunk Carrier Systems	UTP_form_397b.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	397c	Design Specification for Subscriber Carrier Systems	UTP_form_397c.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	397d	Design Specifications for Point to Point Microwave Radio Systems	UTP_form_397d.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	397g	RUS Performance Specification for Line Concentrators	UTP_form_397g.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only
Form	397h	Design Specifications for Digital Lightwave Tranmission Systems	UTP_form_397h.pdf	http://www.usda.gov/rus/telecom/publications/forms.htm	Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 110	Number of Respondents for Small Entity: 110

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,302	920	5,382
Annual IC Time Burden (Hours)	8,807	-1,913	10,720
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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