83-c

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

DHS/UNITED STATES COAST GUARD (USCG)

0066
1625
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Enter only items that change
Current record

New record

Agency form number (s)

CG-6083

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

DHS/USCG is submitting this change request to use the updated version of form CG-6083 "APPLICATION FOR
APPROVAL/REVISION OF VESSEL POLLUTION RESPONSE PLANS". The updates include adding the Privacy Act
Statement and the OMB expiration date. This form will not increase the burden hours for this collection.
Signature of Senior Official or designee:

KENLINISHIA TYLER, COI MANAGER
** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

11/14/2011

For OIRA Use
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