Gas Pipeline Safety Program Certification and Hazardous Liquid Pipeline Safety Program Certification

Forms and Documents

Document Name	Status
Form PHMSA F 999-95 Gas Pipeline Safety Program Certification and Hazardous Liquid Pipeline Safety Program Certification Form and Instruction	Modified
2137-0584_Supporting_Statementrevison.doc Supporting Statement A	2010-10-01

IC Document Collections

IC ID	Document Title	Status
26791	Gas Pipeline Safety Program Certification and Hazardous Liquid Pipeline Safety Program Certification Form and Instruction	Modified

ICR Details

OMB Control No: 2137-0584	ICR Reference No: 201004-2137-001
Status: Historical Active	Previous ICR Reference No: 200809-2137-004
Agency/Subagency: DOT/PHMSA	Agency Tracking No: 2137-0584 Revision
Title: Gas Pipeline Safety Program Certification and Hazardous Liquid Pipeline Safety Program Certification
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/26/2010
	Date Received in OIRA: 06/03/2010
Terms of Clearance: This collection has a shortened approval period, based on PHMSA's inability to accept electronic signatures, to facilitate electronic submission. Upon resubmission, PHMSA should have a plan in place for acceptance of electronic signatures for the forms and submissions associated with this collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	36 Months From Approved	01/31/2012
Responses	67	0	67
Time Burden (Hours)	3,920	0	3,820
Cost Burden (Dollars)	0	0	0

---

Abstract: A state must meet to qualify for certification status to assume regulatory and enforcement responsibility for intrastate pipelines. PHMSA is revising this info collection to incorporate the on-line tool which is used to gather information from the respondents.

---

Authorizing Statute(s): US Code: 49 USC 60102 Name of Law: Federal Pipeline Safety Laws
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 52996	10/15/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 17825	04/07/2010
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Gas Pipeline Safety Program Certification and Hazardous Liquid Pipeline Safety Program Certification	PHMSA F 999-95, PHMSA F 999-92	State HL Certification/Agreement Package ,   State NG Certification/Agreement Package

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	67	67	0	0	0	0
Annual Time Burden (Hours)	3,920	3,820	0	100	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: PHMSA is revising this information collection to incorporate the information collection tools that are used by the respondents. The tools are known as the certification statements which includes a number of “attachments”. These tools were used under the previously approved collection period but were not specifically included as “information collection tools”. The burden hour increase is a result of the addition of questions within Attachment 10 of the Certification statement. The added questions focus on damage prevention and result in a burden increase of an estimated 1.49 hours/respondent which adds a total of approximately 100 hours (67.5 respondents * 1.49 hrs) to the information collection.

---

Annual Cost to Federal Government: $4,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/03/2010

---