Attach2B_Sub-Project_MiniSSA_Template

Mini Supporting Statement A For

“Generic Clearance to Support Programs and Administrative Operations

At the National Cancer Institute (NCI)”

0925-XXXX, Expiration Date xx/xx/20xx

Title of Sub-Project: INSERT TITLE

Contact Person:

Section A.

A1. Circumstances Making the Collection of Information Necessary

A2. Purpose and Use of the Information Collection

A3. Use of Information Technology and Burden Reduction

A4. Efforts to Identify Duplication and Use of Similar Information

A5. Impact on Small Businesses or Other Small Entities

A6. Consequences of Collecting the Information Less Frequently

A7. Special Circumstances Relating to the Guidelines of 5 CFR 1320.5

A8. Comments in Response to Federal Register Notice and Efforts to Consult Outside Agency

A9. Explanation of Any Payment or Gift to Respondents

A10. Assurance of Confidentiality Provided to Respondents

A11. Justification for Sensitive Questions

A12. Estimates of Hour Burden Including Annualized Hourly Costs

Table A12-1. Estimates of Hour Burden

Type of Respondent	Number of Respondents	Number of Responses Per Respondent	Average Burden Per Response (in hours)	Total Burden Hours
Totals

Table A12-2. Cost to Respondents:

Refer to http://www.bls.gov/oes/current/oes_nat.htm.

Type of Respondent	Number of Respondents	Total Annual Burden Hours	Wage Rate	Respondent Cost
Totals

A13. Estimate of Other Total Annual Cost Burden to Respondents or Record Keepers

A14. Annualized Cost to the Federal Government

A15. Explanation for Program Changes or Adjustments

A16. Plans for Tabulation and Publication and Project Time Schedule

A17. Reason(s) Display of OMB Expiration Date Is Inappropriate

A18. Exceptions to Certification for Paperwork Reduction Act Submissions

List of Attachments.

References (if applicable).

2

Short Title: XXXX 9/3/2013