Warehouse Regulations Under the United States Warehouse Act

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form WA-502 Licensing Agreement for Export Food Aid Commodites	Form	Modified	Available
Form WA-460-2 Appendix Grain Electronic Warehouse Receipt (EWR)	Form	Modified	Repair queued
Form WA-490-1 Addendum to the Provider Agreement to Electronically File and Maintain Other Documents	Form	Modified	Available
Form WA-490 Provider Agreement to Electronically File and Maintain Other Electronic Documents	Form	Modified	Available
Form WA-460-13 Addendum to the Provider Agreement to Electronically Fiel and Maintain Orange Juice Warehouse Receipts	Form	Modified	Available
Form WA-460-12 Addendum to the Provider Agreement to Electronically File and Maintain Cocoa Warehouse Receipts	Form	Modified	Available
Form WA-460-11-Coffee Addendum to the Provider Agreement to Electronically File and Maintain Coffee Warehouse Receipts	Form	Modified	Available
Form WA-460-9 Addendum to the Provider Agreement to Electronically File and Maintain Rice Warehouse Receipts	Form	Modified	Available
Form WA-460-8 Addendum to the Provider Agreement to Electronicially Fiel and Maintain Cottonseed Warehouse Receipts	Form	Modified	Available
Form WA-460-7 Addendum to the Provider Agreement to Electronically File and Maintain Sweetener Warehouse Receipts	Form	Modified	Available
Form WA-460-6 Addenum to the Provider Agreement to Electronically File and Maintain Dry Bean Warehouse Receipts	Form	Modified	Available
Form WA-460-5A Addendum to the Provider Agreement to Electronically File and Maintain Peanut Warehouse Receipts and US Warehouse Act Documents	Form	Modified	Available
Form WA-460-5-Nuts Addendum to the Provider Agreement to Electronically File and Maintain Peanut Warehouse Receipts	Form	Modified	Available
Form WA-460-4 Addendum to the Provider Agreement to Electronically File and Maintain Tobacco Warehouse Receipts	Form	Modified	Available
Form WA-460-3 Addendum to the Provider Agreement to Electronically Fiel and Maintain Wool Warehouse Receipts	Form	Modified	Available
Form WA-460-2 Addendum to the Provider Agreement to Electronically Fiel and Maintain Grain Warehouse Receipts and US Warehouse Act Documents	Form	Modified	Available
Form WA-460-1 Addendum to the Provider Agrement to Electronically File and Maintain Cotton Warehouse Receipts	Form	Modified	Available
Form WA-460 Provider Agreement to Electronically File and Maitain Warehouse Receipts and US Warehouse Act Documents	Form	Modified	Available
Form WA-408 Licensing Agreement for Cottonseed	Form	Modified	Available
Form WA-407 Licensing Agreement for Sweeteners	Form	Modified	Available
Form WA-406 Licensing Agreement for Dry Edible Beans	Form	Modified	Available
Form WA-405 Licensign Agreement for Nut Warehouse Operators	Form	Modified	Available
Form Wa-404 Lice nsing Agreement for Tobacco	Form	Modified	Available
Form WA-403 Licensing Agreement for Wool	Form	Modified	Available
Form WA-402 Licensing Agreement for Grain and Rice Warehouse Operators	Form	Modified	Available
Form WA-401 Liscensing Agreement for Cotton Warehouse Operators	Form	Modified	Available
Form WA-400 Addendum to the Terms and Conditions of the Licensing/Provider Agreement	Form	Modified	Available
Form WA-580-1 Transloading Inspection Checklist	Form	Modified	Available
Form WA-580 Port Terminal Inspection Checklist	Form	Modified	Available
Form WA-570 Inventory Adjustment Notice	Form	Modified	Available
Form WA-562 Subsequent Examination Report	Form	Modified	Available
Form WA-561 Original Warehouse Examination Report (Processed Commodities)	Form	Modified	Available
Form WA-372 Schedule of Charges	Form	Modified	Available
Form WA-308 Warehouse Operator's Statement and Examiner's Comparison	Form	Modified	Available
Form WA-303 Original and/or Amendment Examination Report	Form	Modified	Available
Form WA-302 Examination Report	Form	Modified	Available
Form WA-237 Order for Printing U.S. Warehouse Receipt Forms	Form	Modified	Available
Form WA-225 Warehouse Operator's Statement and Examiner's Comparison of Obligated Stocks	Form	Modified	Available
Form WA-222 Examination Report of Individual Buildings	Form	Modified	Available
Form WA-221 Examination Report	Form	Modified	Available
Form WA-220 Examination Report	Form	Modified	Available
Form WA-141 Agreement with Respect to Agricutlural Product Storage Obligations	Form	Modified	Available
Form WA-140 Agreement to Assume Agricultural Product Storage Obligations	Form	Modified	Available
Form WA-139 Certificate of Loss of Canceled Or Uncanceled Warehouse Receipt	Form	Modified	Available
Form WA-125ER Memorandum of Adjustments - Electronic Response	Form	Modified	Available
Form WA-125 Memorandum of Adjustments	Form	Modified	Available
Form WA-105 Returned and Destroyed Receipt Record	Form	Modified	Available
Form WA-91 Agreement to Indemnify	Form	Modified	Available
Form WA-90 Corporate Signature Resolution	Form	Modified	Available
Form WA-89 Consent of Surety to Changes	Form	Modified	Available
Form WA-88 Receipt for Eligible Securities Accepted as Security	Form	Modified	Available
Form WA-87 Receipt for Obligor on Return of Securities	Form	Modified	Available
Form WA-85 Coroperate Power of Attorney	Form	Modified	Available
Form WA-84 Power of Attorney (To sell Securities)	Form	Modified	Available
Form WA-83 Warehouse Operator's Bond	Form	Modified	Available
Form WA-82 Warehouse Operator's Irrevocalble Letter of Credit	Form	Modified	Available
Form WA-81 Rider to Warehouse Operator's Bond	Form	Modified	Available
Form WA-80 Warehouse Operator's Bond	Form	Modified	Available
Form WA-70 Recept Signature Authority	Form	Modified	Available
Form WA-62 Bond to Cover Lost Paper Warehouse Receipts under the U.S. Warehouse Act	Form	Modified	Repair queued
Form WA-51-2 financial Statement Supplement	Form	Modified	Available
Form WA-50 Application for License or Modification of License for the Conduct of a Public Warehouse	Form	Modified	Available
Form WA-53 Applicaton for a License to Inspect, Classify, Sample, and or weigh Agricultural Products under the US Warehouse Act	Form	Modified	Available
supporting document 2015.doc	Supporting Statement A	Uploaded 2015-02-05	Available
FSA0085-0001.6(2014).doc	Supplementary Document	Uploaded 2015-01-06	Available
FSA0085-0001.5 (2014).doc	Supplementary Document	Uploaded 2015-02-05	Available
FSA0085-0001.4(2014).doc	Supplementary Document	Uploaded 2015-01-06	Available
FSA0085-0001.3(2014).doc	Supplementary Document	Uploaded 2015-01-06	Available
FSA0085-0001.2(2014).doc	Supplementary Document	Uploaded 2015-01-06	Available
FSA0085-0001.1(2014).doc	Supplementary Document	Uploaded 2015-01-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Licensing Agreement for Export Food Aid Commodites
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Grain Electronic Warehouse Receipt (EWR)
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically File and Maintain Other Documents
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Provider Agreement to Electronically File and Maintain Other Electronic Documents
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically Fiel and Maintain Orange Juice Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically File and Maintain Cocoa Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically File and Maintain Coffee Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically File and Maintain Rice Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronicially Fiel and Maintain Cottonseed Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically File and Maintain Sweetener Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addenum to the Provider Agreement to Electronically File and Maintain Dry Bean Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically File and Maintain Peanut Warehouse Receipts and US Warehouse Act Documents
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically File and Maintain Peanut Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically File and Maintain Tobacco Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically Fiel and Maintain Wool Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agreement to Electronically Fiel and Maintain Grain Warehouse Receipts and US Warehouse Act Documents
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Provider Agrement to Electronically File and Maintain Cotton Warehouse Receipts
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Provider Agreement to Electronically File and Maitain Warehouse Receipts and US Warehouse Act Documents
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Licensing Agreement for Cottonseed
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Licensing Agreement for Sweeteners
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Licensing Agreement for Dry Edible Beans
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Licensign Agreement for Nut Warehouse Operators
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Lice nsing Agreement for Tobacco
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Licensing Agreement for Wool
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Licensing Agreement for Grain and Rice Warehouse Operators
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Liscensing Agreement for Cotton Warehouse Operators
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Addendum to the Terms and Conditions of the Licensing/Provider Agreement
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Transloading Inspection Checklist
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Port Terminal Inspection Checklist
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Inventory Adjustment Notice
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Subsequent Examination Report
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Original Warehouse Examination Report (Processed Commodities)
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Schedule of Charges
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Warehouse Operator's Statement and Examiner's Comparison
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Original and/or Amendment Examination Report
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Examination Report
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Order for Printing U.S. Warehouse Receipt Forms
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Warehouse Operator's Statement and Examiner's Comparison of Obligated Stocks
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Examination Report of Individual Buildings
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Examination Report
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Examination Report
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Agreement with Respect to Agricutlural Product Storage Obligations
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Agreement to Assume Agricultural Product Storage Obligations
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Certificate of Loss of Canceled Or Uncanceled Warehouse Receipt
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Memorandum of Adjustments - Electronic Response
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Memorandum of Adjustments
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Returned and Destroyed Receipt Record
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Agreement to Indemnify
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Corporate Signature Resolution
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Consent of Surety to Changes
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Receipt for Eligible Securities Accepted as Security
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Receipt for Obligor on Return of Securities
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Coroperate Power of Attorney
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Power of Attorney (To sell Securities)
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Warehouse Operator's Bond
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Warehouse Operator's Irrevocalble Letter of Credit
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Rider to Warehouse Operator's Bond
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Warehouse Operator's Bond
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Recept Signature Authority
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Bond to Cover Lost Paper Warehouse Receipts under the U.S. Warehouse Act
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	financial Statement Supplement
1353	Warehouse Regulations Under the United States Warehouse Act	Instruction	Modified
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Application for License or Modification of License for the Conduct of a Public Warehouse
1353	Warehouse Regulations Under the United States Warehouse Act	Form	Modified	Applicaton for a License to Inspect, Classify, Sample, and or weigh Agricultural Products under the US Warehouse Act

ICR Details

OMB Control No: 0560-0120	ICR Reference No: 201402-0560-008
Status: Historical Active	Previous ICR Reference No: 201107-0560-001
Agency/Subagency: USDA/FSA	Agency Tracking No:
Title: Warehouse Regulations Under the United States Warehouse Act
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/26/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/24/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2018	36 Months From Approved	06/30/2015
Responses	17,872	0	19,320
Time Burden (Hours)	8,163	0	8,817
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection is required for licensing as required by the United State Warehouse Act (USWA)and provides information for issuance of licenses or approval to determine if warehouse operator meets required standards and continues to meet once licensed or approved.

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Authorizing Statute(s): US Code: 7 USC 241-256 Name of Law: USWA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 58314	09/29/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 8843	02/19/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Warehouse Regulations Under the United States Warehouse Act	WA-460-13, WA-460-9, WA-460-5-Nuts, WA-220, WA-402, WA-84, WA-403, Wa-404, WA-490, WA-140, WA-221, WA-62, WA-70, WA-87, WA-88, WA-90, WA-91, WA-80, WA-460-2, WA-460-7, WA-460-8, WA-460-11-Coffee, WA-237, WA-460, WA-405, WA-406, WA-89, WA-141, WA-460-2 Appendix , WA-502, WA-50, WA-51-2, WA-53, WA-81, WA-82, WA-105, WA-125, WA-125ER, WA-302, WA-303, WA-460-3, WA-460-12, WA-85, WA-308, WA-372, WA-225, WA-407, WA-460-6, WA-561, WA-580-1, WA-460-1, WA-400, WA-401, WA-562, WA-83, WA-570, WA-580, WA-460-5A, WA-222, WA-408, WA-460-4, WA-490-1, WA-139	Application for License or Modification of License for the Conduct of a Public Warehouse ,   financial Statement Supplement ,   Applicaton for a License to Inspect, Classify, Sample, and or weigh Agricultural Products under the US Warehouse Act ,   Bond to Cover Lost Paper Warehouse Receipts under the U.S. Warehouse Act ,   Recept Signature Authority ,   Warehouse Operator's Bond ,   Rider to Warehouse Operator's Bond ,   Warehouse Operator's Irrevocalble Letter of Credit ,   Warehouse Operator's Bond ,   Power of Attorney (To sell Securities) ,   Coroperate Power of Attorney ,   Receipt for Obligor on Return of Securities ,   Receipt for Eligible Securities Accepted as Security ,   Consent of Surety to Changes ,   Corporate Signature Resolution ,   Agreement to Indemnify ,   Returned and Destroyed Receipt Record ,   Memorandum of Adjustments ,   Memorandum of Adjustments - Electronic Response ,   Certificate of Loss of Canceled Or Uncanceled Warehouse Receipt ,   Agreement to Assume Agricultural Product Storage Obligations ,   Agreement with Respect to Agricutlural Product Storage Obligations ,   Examination Report ,   Examination Report ,   Examination Report of Individual Buildings ,   Warehouse Operator's Statement and Examiner's Comparison of Obligated Stocks ,   Order for Printing U.S. Warehouse Receipt Forms ,   Examination Report ,   Original and/or Amendment Examination Report ,   Warehouse Operator's Statement and Examiner's Comparison ,   Schedule of Charges ,   Original Warehouse Examination Report (Processed Commodities) ,   Subsequent Examination Report ,   Inventory Adjustment Notice ,   Port Terminal Inspection Checklist ,   Transloading Inspection Checklist ,   Addendum to the Terms and Conditions of the Licensing/Provider Agreement ,   Liscensing Agreement for Cotton Warehouse Operators ,   Licensing Agreement for Grain and Rice Warehouse Operators ,   Licensing Agreement for Wool ,   Lice nsing Agreement for Tobacco ,   Licensign Agreement for Nut Warehouse Operators ,   Licensing Agreement for Dry Edible Beans ,   Licensing Agreement for Sweeteners ,   Licensing Agreement for Cottonseed ,   Provider Agreement to Electronically File and Maitain Warehouse Receipts and US Warehouse Act Documents ,   Addendum to the Provider Agrement to Electronically File and Maintain Cotton Warehouse Receipts ,   Addendum to the Provider Agreement to Electronically Fiel and Maintain Grain Warehouse Receipts and US Warehouse Act Documents ,   Addendum to the Provider Agreement to Electronically Fiel and Maintain Wool Warehouse Receipts ,   Addendum to the Provider Agreement to Electronically File and Maintain Tobacco Warehouse Receipts ,   Addendum to the Provider Agreement to Electronically File and Maintain Peanut Warehouse Receipts ,   Addendum to the Provider Agreement to Electronically File and Maintain Peanut Warehouse Receipts and US Warehouse Act Documents ,   Addenum to the Provider Agreement to Electronically File and Maintain Dry Bean Warehouse Receipts ,   Addendum to the Provider Agreement to Electronically File and Maintain Sweetener Warehouse Receipts ,   Addendum to the Provider Agreement to Electronicially Fiel and Maintain Cottonseed Warehouse Receipts ,   Addendum to the Provider Agreement to Electronically File and Maintain Rice Warehouse Receipts ,   Addendum to the Provider Agreement to Electronically File and Maintain Coffee Warehouse Receipts ,   Addendum to the Provider Agreement to Electronically File and Maintain Cocoa Warehouse Receipts ,   Addendum to the Provider Agreement to Electronically Fiel and Maintain Orange Juice Warehouse Receipts ,   Provider Agreement to Electronically File and Maintain Other Electronic Documents ,   Addendum to the Provider Agreement to Electronically File and Maintain Other Documents ,   Grain Electronic Warehouse Receipt (EWR) ,   Licensing Agreement for Export Food Aid Commodites

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	17,872	19,320	0	-48	-1,400	0
Annual Time Burden (Hours)	8,163	8,817	0	-54	-600	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This information collection represents an adjustment since there has been a decrease in the number of hours from the last OMB approval. The previous number of burden hours requested was 8,817 as compared to the burden hours requested in this package of 8,163 hours for a difference of minus 654 hours. Many of our licensed entities have combined locations thereby making their operation more efficient to run with less reporting and recordkeeping requirements. One form was removed from this request, and this is a minor adjustment is reflected in the total. As new technologies become affordable, warehouse operators as well as FSA avail themselves of such, adding efficiencies to the system of keeping records. The consolidation and growth of warehouses and farms has been a definite trend, which leads to fewer entities for which records need to be kept.

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Annual Cost to Federal Government: $443,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/24/2015

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