71

APHIS 71 2013.xlsx

Importation of Fresh Beans, Shelled or in Pods, from Jordan into the Continental United States

71

OMB: 0579-0405

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 of Fresh Beans from Jordan 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)
319-56.57 Phytosanitary Certificates (NPPO) (Foreign Federal Gov) None 1 10.00 10.00 1.00 10.00

0.00
319-56.57 Packing House Registration (Business) None 5 1.0000 5.00 1.0000 5.00

0.00
319-56-57 Box labeling (Business - same respondents as above) None 5 2.0000 10.00 0.0160 0.16

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL
6
25.00
15.16 0.00
0.00

TOTAL OF ALL PAGES


25.00
15.16 0.00
0.00
TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c
6
25.00
15.16















































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.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

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