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pdfTITLE OF INFORMATION COLLECTION DOCUMENT
OMB NO.
Self-Certification Medical Statement
FORM NO.
OR OTHER
IDENTIFICATION
(A)
TOTAL
ANNUAL
RESPONSES
(B)
0579-
AVE. TIME
PER
RESPONSE
(C)
APHIS FORM 79 (SEP 96)
524
0.167
PREPARED BY
02/02/2011
Eric Williams
ESTIMATED ANNUAL PROGRAM COSTS FOR COLLECTING,
PROCESSING, ANALYZING, TABULATING AND/OR
PUBLISHING THE INFORMATION COLLECTED
(Do NOT include administrative costs such as printing, and mailing of
forms, etc.)
TOTAL
HOURS
PER YEAR
(B x C)
GRADE AND AVERAGE HOURLY RATE OF
PROGRAM PERSON(S) INVOLVED IN THE
INFORMATION COLLECTION (Include field AND
headquarters personnel. Use step 4 for average
hourly rate.)
(D)
1. . . . OF .1. . .
TOTAL
COSTS
(F+G)
(G)
(F)
$
$
PAGE
OVERHEAD
COSTS
(Col. F
times .139)
PROGRAM
COSTS
(D X E)
(E)
GS-
MRP-5
0196
DATE PREPARED
REMARKS
(H)
$
$
2,881
400
3,281
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
87.51
11
32.92
WORKSHEET FOR CALCULATING COSTS TO THE FEDERAL GOVERNMENT FOR INFORMATION COLLECTION
USDA - APHIS
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| File Type | application/pdf |
| File Title | c:\informs\forms\aphis79.wpf |
| Author | kastratchko |
| File Modified | 2011-02-02 |
| File Created | 2007-05-09 |