71

APHIS 71 for Citus Canker, GS NS.xls

Citrus Canker, Citrus Greening, and Asian Citrus Psyllid; Interstate Movement of Regulated Nursery Stock

71

OMB: 0579-0369

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.

























Citus Canker, Citrus Greening, and Asian Citrus Psyllid; Interstate Movement of Regulated Nursery Stock - APHIS 2010-0048 0579-































DATE PREPARED




















February 9, 2011

















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)








301.75-6, 76-6, 76-7 Labeling requirements (CA, LA, TX, and FL) (business) None 27 274.0000 7,398.00 0.0200 147.96

0.00








301.75-6, 76-7, 76-7 Recordkeeping of Nursery (CA, LA, TX, FL) (business) (10 of the respondents are the same respondents that label boxes) None

0.00
0.00 15 0.083 1.00








301.75-6, 76-6, 7, 8 Compliance Agreements (business PPQ 519 569 1.0000 569.00 1.2500 711.25

0.00








301.76-6 ( c) Limited Permit, LA, AZ, CA (business) PPQ 530 25 104.0000 2,600.00 0.2000 520.00

0.00







301-75-6, 76-7 Federal Certificate (business) (same respondents as PPQ 530 PPQ 540 25 104.0000 2,600.00 0.2000 520.00

0.00













0.00
0.00

0.00









SUBTOTAL
621
13,167.00
1,899.21 15.00
1.00









TOTAL OF ALL PAGES


13,167.00
1,899.21 15.00
1.00








TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c


13,182.00
1,900.21



















































































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.


























0579-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
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.


























0581-































DATE PREPARED







































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)













0.00
0.00

0.00













0.00
0.00

0.00













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
0.00








File Typeapplication/vnd.ms-excel
Authoruser
Last Modified Bykastratchko
File Modified2011-02-17
File Created2000-01-10

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