Aphis 71

APHIS Form 71b.xls

Animal Welfare

APHIS 71

OMB: 0579-0093

Document [xlsx]
Download: xlsx | pdf















INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24, 2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.66(b)(1(iii), 3.6(c)(1(ii), 3.6(d) Approval for less than minimum housing requirements for dogs and cats BUSINESS None 30 1.0000 30.00 1.0000 30.00 30 0.500 15.00
3.8(b)(1)(2) Proposal approved by research facility committee and attending veternarian BUSINESS None 750 1.0000 750.00 1.0000 750.00

0.00
3.8(c)(1) Consultaton and review by the committee and attending veterinarian BUSINESS None 800 1.0000 800.00 1.0000 800.00

0.00
3.8(c)(3)(iii) Written standard procedures (plan) for exercise and recording thereof BUSINESS None 3,000 1.0000 3,000.00 2.0000 6,000.00 3,000 1.000 3,000.00
3.8(d)(1)(3) Documentation for exercise exemption and recordkeeping BUSINESS None 500 5.0000 2,500.00 0.5000 1,250.00 500 1.000 500.00
3.8(d)(2) Review by committee, exemptions for dogs and cats BUSINESS None 200 10.0000 2,000.00 1.0000 2,000.00

0.00

SUBTOTAL


9,080.00
10,830.00 3,530.00
3,515.00

TOTAL OF ALL PAGES





11687 148,381.00
44,106.00 10,010.00
3,515.00
TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c







157,491.00
47,615.00















































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24, 2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.13(b), 3.86(b) Consignment to carriers and intermediate handlers BUSINESS None 4,794 1.0000 4,794.00 0.1000 479.40

0.00

Consignment to carriers and intermediate handlersSTATE/LOCAL None 206 1.0000 206.00 0.1000 20.60

0.00
3.13( c) (1)(2)(3)(4), 3.16(a), 3.86(c),(1)(2) (3)(4), 3.89(a) Certification by consignor for transport consignor name and address, ID, tag number of tattoo, and each animal offered food and water (dogs, cats, primates) BUSINESS None 4,894 1.0000 4,894.00 0.2500 1,223.50

0.00

Certification by consignor for transport consignor name and address, ID, tag number of tattoo, and each animal offered food and water (dogs, cats, primates) STATE/LOCAL None 206 1.0000 206.00 0.2500 51.50

0.00
3.13(c), 3.14(h), 3.16(b), 3.36(h), 3.61(g), 3.86(c) Shipping documents and written instructions for food, water, medication, and special care attached to enclosure. Numbers accounted for under 3.113(g). BUSINESS None 5,385 1.0000 5,385.00 0.0500 269.25

0.00
3.61(g), 3.86(c) Shipping documents and written instructions for food, water, medication, and special care attached to enclosure. Numbers accounted for under 3.113(g). STATE/LOCAL None 315 1.0000 315.00 0.0500 15.75

0.00

SUBTOTAL


15,800.00
2,060.00 0
0.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24, 2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.137(f), 3.139(d), Certification by consignor and attending veterinarian that animal is acclimated to temperatures outside requirements. BUSINESS 2050 None 2,050 15.0000 30,750.00 0.2500 7,687.50

0.00
3.13(e), 3.19(a)(3), 3.35(c), 3.37(g), 3.60(c), 3.62(g), 3.77(a), 3.78(a), 3.86(e), 3.92(a)(3), 3.112( c), 3.118(a)(2)(3) Certification by consignor and attending veterinarian that animal is acclimated to temperatures outside requirements. STATE/LOCAL 50 None 50 15.0000 750.00 0.2500 187.50

0.00
3.60(c), 3.62(g), 3.77(a), 3.78(a), 3.86(e)









3.86(c), 3.92(a)(3), 3.112(c), 3.118(a)(2)(3)





















SUBTOTAL


31,500.00
7,875.00 0
0.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24, 2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.13(f), 3.35(d), 3.60(d), 3.86(f), Attempt to notify consignee-recordkeeping. BUSINESS





2,275 1.000 2,275.00
3.112(d), 3.86(f), 3.112(d), 3.136(d) Attempt to notify consignee-recordkeeping. STATE/LOCAL





25 1.000 25.00











3.14(a)(6), 3.19(b)(2), 3.36(g), 3.61(f) Marking requirements for transport enclosure ("live animal") BUSINESS None 5,500 1.0000 5,500.00 0.0500 275.00

0.00
3.87(f), 3.113(f), 3.137(e), 3.92(b)(2) Marking requirements for transport enclosure ("live animal") STATE/LOCAL None 500 1.0000 500.00 0.0500 25.00

0.00












SUBTOTAL


6,000.00
300.00 2,300
2,300.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24, 2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.77(f), 3.78(d), 3.103(c), 3.127(d) Perimeter fencing variance from requirements BUSINESS None 165 1.0000 165.00 1.0000 165.00

0.00

Perimeter fencing variance from requirements STATE/LOCAL None 35 1.0000 35.00 1.0000 35.00

0.00
3.28(c)(3), 3.53(c)(3), 3.80(b)(2)(iii) Innovative housing approval (hamster, guinea pigs, rabbits, primates) BUSINESS None 39 1.0000 39.00 1.0000 39.00

0.00

Innovative housing approval (hamster, guinea pigs, rabbits, primates) STATE/LOCAL None 1 1.0000 1.00 1.0000 1.00

0.00
3.80(c),3.83 Review by Committee - exemptions for primates BUSINESS None 100 1.0000 100.00 1.0000 100.00

0.00
3.81 Plan for environmental enhancement-recordkeeping BUSINESS None 800 1.0000 800.00 1.0000 800.00 800 1.000 800.00

Plan for environmental enhancement-recordkeeping STATE/LOCAL None 200 1.0000 200.00 1.0000 200.00 200 1.000 200.00
3.8(d) Committee approval for restraint devices for environmental enhancement BUSINESS None 200 1.0000 200.00 2.0000 400.00

0.00

SUBTOTAL


1,540.00
1,740.00 1,000
1,000.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24, 2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.81(e)(1)(2) (3) Exemptions and recordkeeping for environmental enhancement BUSINESS None 800 1.0000 800.00 2.0000 1,600.00 800 1.000 800.00

Exemptions and recordkeeping for environmental enhancement STATE/LOCAL None 200 1.0000 200.00 2.0000 400.00 200 1.000 200.00
3.100(g) Research variance requests BUSINESS None 1 1.0000 1.00 1.0000 1.00

0.00
3.111(e)(5) Written rules and instructions BUSINESS None 15 1.0000 15.00 1.0000 15.00 15 0.100 1.50

Written rules and instructions STATE/LOCAL None 10 1.0000 10.00 1.0000 10.00 10 0.100 1.00
3.111(c)(8) Written criteria for termination of interactive session BUSINESS None 15 1.0000 15.00 1.0000 15.00 15 0.100 1.50

Written criteria for termination of interactive session STATE/LOCAL None 10 1.0000 10.00 1.0000 10.00 10 0.100 1.00
3.111(f)(3)(4) Feeding, behavioral, water quality, and medical records for SWTD programs BUSINESS None 15 2190.0000 32,850.00 0.1000 3,285.00 15 0.200 3.00

Feeding, behavioral, water quality, and medical records for SWTD programs STATE/LOCAL None 10 2190.0000 21,900.00 0.1000 2,190.00 10 0.200 2.00
3.111(f)(5) SWTD program summary reports BUSINESS None 15 365.0000 5,475.00 0.2000 1,095.00 15 52.000 780.00

SWTD program summary reports STATE/LOCAL None 10 365.0000 3,650.00 0.2000 730.00 10 52.000 520.00

SUBTOTAL


64,926.00
9,351.00 1,100
2,310.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24, 2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.111(f)(5) SWTD program changes submitted to APHIS semiannually BUSINESS None 15 2.0000 30.00 0.5000 15.00 15 2.000 30.00

SWTD program changes submitted to APHIS semiannually STATE/LOCAL None 10 2.0000 20.00 0.5000 10.00 10 2.000 20.00
3.101(a)(3) Written protocol for cleaning enclosures surfaces BUSINESS None 31 1.0000 31.00 0.5000 14.00 31 0.100 3.00

Written protocol for cleaning enclosures surfaces STATE/LOCAL None 99 1.0000 99.00 0.5000 50.00 99 0.100 10.00
3.101(b) Written contingency plans BUSINESS None 31 1.0000 31.00 0.5000 15.50 31 1.000 31.00

Written contingency plans STATE/LOCAL None 99 1.0000 99.00 0.5000 49.50 99 1.000 99.00

SUBTOTAL


310.00
154.00 285
193.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24,2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.104(a)(1) Written justificaiton to hold animals in noncompliant enclosures BUSINESS None 10 1.0000 10.00 1.0000 10.00 10 0.100 1.00

Written justificaiton to hold animals in noncompliant enclosures STATE/LOCAL None 20 1.0000 20.00 1.0000 20.00 20 0.100 2.00
3.105(c) Report inappetenance exceeding 24 hours; maintain feeding records for 1 year BUSINESS None 31 30.0000 930.00 0.2000 186.00 31 3.000 93.00

Report inappetenance exceeding 24 hours; maintain feeding records for 1 year STATE/LOCAL None 99 30.0000 2,970.00 0.2000 594.00 99 3.000 297.00
3.106(b) Water quality records BUSINESS None 31 52.0000 1,612.00 0.2000 322.00 31 5.200 161.00

Water quality records STATE/LOCAL None 99 52.0000 5,148.00 0.2000 1,030.00 99 5.200 515.00
3.108(b) Documentation of training for employees - participation and completion BUSINESS None 31 3.0000 93.00 0.2000 19.00 31 3.000 93.00

Documentation of training for employees - participation and completion STATE/LOCAL None 99 3.0000 297.00 0.2000 54.00 99 3.000 297.00
3.109 Written plans for animals housed separately BUSINESS None 11 1.0000 11.00 0.5000 5.00 11 0.500 5.00

Written plans for animals housed separately STATE/LOCAL None 39 1.0000 39.00 0.5000 20.00 39 0.500 20.00
3.110(b) Medical isolation BUSINESS None 6 1.0000 6.00 0.5000 3.00 6 0.500 3.00

Medical isolation STATE/LOCAL None 14 1.0000 14.00 0.5000 7.00 14 0.500 7.00

SUBTOTAL


11,150.00
2,270.00 490
1,494.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24, 2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.110(d), Individual animal medical records BUSINESS None 31 8.0000 248.00 0.5000 124.00 31 0.500 15.00

Individual animal medical records STATE/LOCAL None 99 8.0000 792.00 0.5000 396.00 99 0.500 50.00
3.110(e) Veterinary care records for transport BUSINESS None 31 5.0000 155.00 0.2000 31.00



Veterinary care records for transport STATE/LOCAL None 99 5.0000 495.00 0.2000 99.00


3.110(f) Exception from annual examination for cetaceans and sirenians BUSINESS None 10 2.0000 20.00 0.5000 10.00 10 0.200 2.00

Exception from annual examination for cetaceans and sirenians STATE/LOCAL None 10 2.0000 20.00 0.5000 10.00 10 0.200 2.00
3.110(g), 3.111(g)(6) Preliminary and final necropsy reports BUSINESS None 31 3.0000 93.00 1.0000 93.00 31 0.250 7.75

Preliminary and final necropsy reports STATE/LOCAL None 99 3.0000 297.00 1.0000 297.00 99 0.250 24.75
3.111(f)(1) Description of SWTD program submitted to APHIS, BUSINESS APHIS 7002 15 1.0000 15.00 1.0000 15.00 15 0.100 1.50

Description of SWTD program submitted to APHIS, STATE/LOCAL APHIS 7002 10 1.0000 10.00 1.0000 10.00 10 0.100 1.00

SUBTOTAL


2,145.00
1,085.00 305
104.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare -0579-0093 0579-0093




DATE PREPARED


February 24, 2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.111(f)(7) Injury report within 24 hours, written report with 7 days STATE/LOCAL None 1 1.0000 1.00 1.0000 1.00

0.00
3.111(g)(3) Dolphin profile - accounted for under 3.111(f)(3)(4) None 0 0.0000 0.00
0.00

0.00
3.111(g)(4) Nutritional and repoductive status BUSINESS None 15 16.0000 240.00 0.2500 60.00

0.00

Nutritional and repoductive status STATE/LOCAL None 10 16.0000 160.00 0.2500 40.00

0.00
3.111(g)(5) Written assessment by veterinarian BUSINESS None 15 4.0000 60.00 0.5000 30.00

0.00

Written assessment by veterinarian STATE/LOCAL None 10 4.0000 40.00 0.5000 20.00

0.00
3.112(a), 3.116(b)(4) Health certificate for transport - marine mammals and primates BUSINESS None 325 6.0000 1,950.00 0.2000 390.00

0.00

Health certificate for transport - marine mammals and primates STATE/LOCAL None 75 6.0000 450.00 0.2000 90.00

0.00
3.113( g), 3.118(a)(2) Acclimation Certificate BUSINESS None 129 1.0000 129.00 0.1000 12.90

0.00

SUBTOTAL


3,030.00
643.90 0
0.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24, 2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.116(a) Transport plan - marine mammals BUSINESS None 31 5.0000 155.00 0.2000 31.00

0.00

Transport plan - marine mammals STATE/LOCAL None 99 5.0000 495.00 0.2000 99.00

0.00

From Collection 0579-0092






0.00
3.35(b), 3.60(b) Certificate that shipping crate complies with Section 3.36 BUSINESS APHIS 7020 & 7020A 70 5.0000 350.00 0.1000 35.00

0.00
3.35 (c) , 3.37(g) Acclimation Certification for Hamsters (Optional) BUSINESS None 20 10.0000 200.00 0.1000 20.00

0.00
3.60(c), 3.62(g) Acclimation Certification for Rabbits (Optional) BUSINESS None 80 5.0000 400.00 0.1000 40.00

0.00



0 0.0000 0.00
0.00 0.00 0.00 0.00

SUBTOTAL


1,600.00
225.00 0
0.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Animal Welfare - 0579-0093 0579-0093




DATE PREPARED


February 24,2009
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN








REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)








RESPONDENT



KEEPER
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)
3.35(d), 3.60(d) Carrier or intermediate handler attempt to notify consignor BUSINESS None 0 0.0000 0.00
0.00 1,000 0.100 100.00
3.36(g), 361(f) Primary enclosure marked with letters "Live Animals" and arrows BUSINESS None 1,300 1.0000 1,300.00 0.0500 65.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


1,300.00
65.00 1,000
100.00













































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0














































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.








0581-




DATE PREPARED






IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN






















REPORTS RECORDS










TOTAL














RECORD-






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL KEEPING HOURS
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER (Col. I x J)
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD-








RESPONDENT



KEEPER (K)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) 0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0

File Typeapplication/vnd.ms-excel
Authoruser
Last Modified Bycbsickles
File Modified2009-08-20
File Created2000-01-10

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