Aphis 71

BSE 71 3 30 11.xlsx

Bovine Spongiform Encephalopathy; Importation of Animals and Animal Products

APHIS 71

OMB: 0579-0234

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.







Importation Prohibitions Because of Bovine Spongiform Encephalopathy 0579-0234




DATE PREPARED


March 1, 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)
95.4 Import Permit Application (Business) VS 16-3 574 1.00 574.00 0.50 287.00

0.00
95.29 Certificate for Inedible Processed Animal Origin Materials and Products from BSE-free Regions (Foreign Government) None 13 1.00 13.00 1.00 13.00

0.00
95.4 Cooperative Service Agreement (signature only) (Business) None 1 1.00 1.00 0.02 1.00

0.00
94.27, and 95.4 Certification Statement for Products from BSE Minimal Risk Regions and Japan, … (signature only) (Foreign Government) None 1,461 38.00 55,518.00 0.02 1,110.36

0.00
93.436 Seals (Foreign Government) None 3,000 20.00 60,000.00 1.00 60,000.00

0.00
93.419 Notification of Designation of Persons Authorized to Break Seals (Business) None 900 6.00 5,400.00 0.25 1,350.00

0.00

SUBTOTAL


121,506.00
62,761.36 0.00
0.00

TOTAL OF ALL PAGES


125,289.00
70,324.36 0.00
0.00
TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c


125,289.00
70,324.36















































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.







Importation Prohibitions Because of Bovine Spongiform Encephalopathy 0579-0234




DATE PREPARED


March 1, 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)
93.420 Agreement with Slaughter Facilities Concerning the Use of Seals on Conveyances Transporting Animals from BSE Minimal Risk Regions (Business) None 1 1.00 1.00 0.02 1.00

0.00
93.420 Notification Regarding Conditions of Sealed Shipments (Business) None 1 1.00 1.00 0.02 1.00


93.405, 93.436 Animals Imported for Immediate Slaughter (Business) VS-17-33 35 108.00 3,780.00 2.00 7,560.00

0.00
93.436 Certification Statement for Ruminants (Signature Only) (Foreign Government) None 1 1.00 1.00 0.02 1.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


3,783.00
7,563.00

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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


0.00
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


















FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL

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




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








RESPONDENT


KEEPERS RECORD- (Col. I x J)
(A) (B) (C) (D) (E) (F) (G) (H)
KEEPER





0.00
0.00 (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

SUBTOTAL


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0.00












0
0.00
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