PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET

Part II: Information Collection Detail

This template is intended for staff without an ICRAS account. Please fill out and submit to the appropriate Operating Division to enter into ICRAS. The form mirrors the screens available in the ICRAS 4 system. To request an account to log into ICRAS. Instructions for filling out the form are available at www.paperworkreduction.gov.

1. Title Antimicrobial Use and Resistance (AUR) – Pharmacy Data
2. Is this a Common Form?	3. Obligation to respond (check one)	4. Frequency of reporting (check all that apply)
Yes x No	a. X Voluntary b. Required to obtain or retain benefits c. Mandatory	a. Hourly (24 -7) b. __ Hourly Bus (40 per week) c. Daily (7 per week) d. Daily Bus (5 per week) e. Weekly (52 per year) f. Monthly g. x Yearly h. Every Decade i. Quarterly j. Semi-annually k. Biennially l._ __ Once m. ___ occasionally
CFR Citation(s) for the information collection under review (if applicable). Title _______ Part __________________ Section________________________ Title _______ Part __________________ Section________________________ Title _______ Part __________________ Section________________________ Title _______ Part __________________ Section________________________
6. Information Collection Instruments – Send all instruments along with the Part 2 form(s). If more than one Part 2 is completed make sure to identify which instruments are associated with which Part 2 form.
7. Federal Enterprise Architecture Business Reference Model (Select one Services for Citizens Line of Business and one Subfunction from its group) Services for Citizens Line of Business Subfunction None Community and Social Services___ Homeownership Promotion___ Community and Regional Development___ Social Services___ Postal Service___ None___ Correctional Activities___ Criminal Incarceration Criminal Rehabilitation None Defense and National Security___ Strategic National and Theater Defense___ Operational Defense___ Tactical Defense___ None___ Disaster Management___ Disaster Monitoring and Predication___ Disaster Preparedness and Planning___ Disaster Repair and Restore___ Emergency Response___ None___ Economic Development___ Business and Industry Development___ Intellectual Property Protection___ Financial Sector Oversight___ Industry Sector Income Stabilization___ None___ Education___ Elementary, Secondary, and Vocational Education___ Higher Education___ Cultural and Historic Preservation___ Cultural and Historic Exhibition___ None___ Energy___ Energy Supply___ Energy Conservation and Preparedness___ Energy Resource Management___ Energy Production___ None___ Environmental Management___ Environmental Monitoring and Forecasting___ Environmental Remediation___ Pollution Prevention and Control___ None___ General Science and Innovation___ Scientific and Technological Research and Innovation___ Space Exploration and Innovation ___ None___ Health_X__ Illness Prevention___ Immunization Management___ Public Health Monitoring_X__ Health Care Services___ Consumer Health and Safety___ None___ Homeland Security___ Border and Transportation Security___ Key Asset and Critical Infrastructure Protection___ Catastrophic Defense___ None___ Income Security___ General Retirement and Disability___ Unemployment Compensation___ Housing Assistance___ Food and Nutrition Assistance___ Survivor Compensation___ None___ Intelligence Operations___ Intelligence Planning and Direction/Needs___ Intelligence Collection___ Intelligence Analysis and Production___ Dissemination___ None___ International Affairs and Commerce___ Foreign Affairs___ International Development and Humanitarian Aid___ Global Trade___ None___ Law Enforcement___ Criminal Apprehension___ Criminal Investigation and Surveillance___ Citizen Protection___ Crime Prevention___ Leadership Protection___ Property Protection___ Substance Control___ None___ Litigation and Judicial Activities___ Judicial Hearing___ Legal Defense___ Legal Investigation___ Legal Prosecution and Litigation___ Resolution Facilitation ___ None___ Natural Resources___ Water Resource Management___ Conservation, Marine and Land Management___ Recreational Resource Management and Tourism___ Agricultural Innovation and Services___ None___ Transportation___ Air Transportation___ Ground Transportation___ Water Transportation___ Space Operations___ None___ Workforce Management___ Training and Employment___ Labor Rights Management___ Worker Safety___ None___ See http://www.feapmo.gov for the Business Reference Model categories and definitions.
8. Privacy Act System of Records (if applicable) Title: Federal Register Citation: Volume ________ Page number ____________ Publication date / /____
9. Respondents
a. Total # 1,500 b. Small Entity # _________ c. Percent Electronic 100 ___________	Affected public (choose one) a. Individuals or households b. x Private Sector c. State, Local, or Tribal Governments d. Federal Government (if Private Sector check all that apply) a. Business or other for-profits b. x Not-for-profit institutions c. Farms
10. Frequency: How often on average will each respondent respond to the Information Collection? Number of Responses per Respondent ____36______ Per (select the most appropriate time period for this collection) a. Hour (24-7) - 8736 per year b. Business Hour (40 per week) - 2080 per year c. Day (7 per week) - 364 per year d. Business Day (5 per week) - 260 per year e. Week - 52 per year f. Month - 12 per year g. x Year h. Decade .1 per year i. Quarter - 4 per year j. Half-Year - 2 per year k. Biennial - 0.5 per year
Calculated: Annual Frequency =_______36________ times a year (per respondent)
Calculated: Annual Number Of Responses = __54,000_____________ a year

11. Hour and Cost Burden Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.
Time per Response	Hour per response	Annual Hour Burden	Cost per Response	Annual cost Burden
Reporting	2	2	108,000	$34.65	$1,423,440.00
Record keeping
Third party disclosure
Total

Allocate the change in burden

Total Requested	Change Due to New Statute	Change Due to Agency Discretion	Due to Agency Estimate	Change Due Violation	Currently Approved
a. Annual Responses	54,000	63,280	720
b. Annual Hour Burden	108,000 hour	hours	hour	106,560 hours	hours	1,440 hours
c. Annual Cost Burden	$1,423,440.00	$	$1,406.592.00	$	$16,848.00