OMB 83-c

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

DHS/UNITED STATES COAST GUARD (USCG)

0080
1625
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Enter only items that change
Current record

New record

Agency form number (s)

Annual reporting and recordkeeping hour
burden
Number of respondents

23485

24985

Total annual responses

6392

6642

Percent of these responses
collected electronically

10

%

25

%

Total annual hours
Difference

250

Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)

250

Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

This request is to add an additional survey to the collection. The reason for the increase of burden hours is due to this
request to add this additional survey.
Signature of Senior Official or designee:

ARTHUR A. REQUINA, COI MANAGER
** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

8/7/2007

For OIRA Use
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10/95