Aphis 71

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 ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

93.101(c)(1)

90-day Written Bird Possession Statement - Canada - Individual or Household

none

150

1.0000

150.00

0.2500

37.50

0.00

93.101(b)(3)(ii), (iii), (iv)(A), (vi), (vii), (c)(2)(i)(B), (C)(ii), (c)(2)(i)(C), (ii)(D), (c)(2)(ii)(C), (f)(1)(ii) and (iii), and (f)(3)(i) ; .106(a); .427(b)(2), (c)(1) and (3); .436(a)(1), (2), (4), (5) and (b)(1), (2)(i)-(iii); .504

Recordkeeping – Identification Marks on Imported Animals - Individuals or Households

none

0.00

0.00

7,272

0.160

1,163.52

Business

0.00

0.00

37,362

0.160

5,977.92

Farms

0.00

0.00

28,089

0.160

4,494.24

93.101(c)(2)(ii)(E)(1), (c)(2)(ii)(E)(2)(i), (f)(2)(iii)(B)(1); 93.201(3)(B)(1)

Agreement of Pet BirdOwner

VS 17-8

80

1.0000

80.00

0.5000

40.00

0.00

93.101(a)(1) and 93.204(a)

Import Permit to Transit Poultry, Hatching Eggs, or Birds - Business

VS 17-135A

108

4.0000

432.00

0.1900

82.08

0.00

SUBTOTAL

338.00

662.00

159.58

72,723.00

11,635.68

TOTAL OF ALL PAGES

3,161.00

48,130.00

14,192.45

73,267.00

17,730.43

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

121,397.00

31,922.88

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 ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

93.103(a)(1)(i)-(x)

Application and Space Reservation Request for Ratites and Ratite Hatching Eggs and Site Inspection - Business

VS 17-128

1

1.0000

1.00

1.0000

1.00

0.00

93.101(b)(3)(iv)(A), (B), (C)

Daily Register for Owner or Manager for Ratites and Hatching Eggs - Business

none

1

1.0000

1.00

0.2500

0.25

0.00

93.101(b)(3)(iv)(A), (B), (C)

Daily Register and Recordkeeping for Owner or Manager for Ratites and Hatching Eggs - Individuals or household

none

0.00

0.00

1

9.000

9.00

93.101(c)(2)(ii)(E)(1), (f)(2)(iii)(A); .201(c)(2)(iii)(A); .206(a);.217(b); .219; .214(b); .301(b)(2); .305(a) and (b); .407(a) and (b); .417(b); .425; .501(b)(2); .520; .521; .804

Declaration of Importation of Animals, Animal Semen, Embryos, Birds, Poultry, and Eggs for Hatching

VS 17-29

0.00

0.00

0.00

Business

226

10.0000

2,260.00

0.1900

429.40

0.00

Farms

188

3.0000

564.00

0.1900

107.16

0.00

SUBTOTAL

416.00

2,826.00

537.81

1

9.00

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.

IMPORTATION OF ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

August 1, 2013

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)

93.101(b)(3)(v)

Owner or Manager and Country of Export Quarterly Submission of Registers - Individuals or households

none

20

4.0000

80.00

0.0500

4.00

0.00

93.101(b)(3)(vi) and (vii)

Recordkeeping - National Exporting Country Registers and Maintenance of Current Production Records, Additions to Such Premises, and Ceiling Limitations - Federal Government

none

0.00

0.00

20

4.000

80.00

93.103(a)(2)(vii)

Request for Hearing for Withdrawal of an Import Permit for Ratites or Ratite Hatching Eggs - Business

none

1

1.0000

1.00

6.0000

6.00

0.00

93.101(b)(3)(ix); 93.103(a)(2)(iv)

Random Inspections of Ratite Farms per Breeding Season of Premises for Required Identification and Recording on Quarterly Report of Registers - Foreign federal government

none

1

1.0000

1.00

1.5000

1.50

0.00

93.106(a), (c), (c)(5)(i)-(iii)

Cooperative Agreement and Trust Fund for Birds (includes providing a list of current employees to port vet signed statement from each designated employee written instructions to monitoring agency, telephone numbers of cooperators, written request for accounting of funds, and written termination) - Business

none

12

2.0000

24.00

2.0000

48.00

0.00

93.106(c)(2)(iii)

Daily Log and Recordkeeping for Identification Record for Birds - Business

VS 17-12

12

1.0000

12.00

0.0830

1.00

0.00

SUBTOTAL

46.00

118.00

60.50

20

80.00

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.

IMPORTATION OF ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

93.106(c)(4)

Additional Requirements for the Quarantine of Birds - Business

none

1

1.0000

1.00

2.0000

2.00

0.00

93.103(a)(1), .204(a), .214(a), .218(a), .217(c), .301(a), .304, .404(a)(1), .417(a), .422(a), .424(a), .435(g)(2), .504(a), .802; 98.4; .10a(b); .34; .36(a)(2) and (b)(2)

Application for Import or In-Transit Permit (for Live Animals, Animal Semen, Animal Embryos, Birds, Poultry, or Hatching Eggs - Business

VS 17-129

582

10.0000

5,820.00

0.1900

1,105.80

0.00

93.301(a), .304(a), .404(a)(4)(ii), .412(a), .417(a), .422(a), .424(a), .504(a), .802(a); 98.4(a), .10, .34(a), .36(a)

Request Space at USDA Operated Quarantine Facilities and Includes Mailing Copies - Business

none

1

1.0000

1.00

0.0330

0.03

0.00

93.104(a); .204(a); .214(a); .218(a); .217(c); .301(c)(2)(iii); .314(a); .317(a); .320; .326; .404(a); .405; 406(a) and (b); .418(a), (b), and (c); .423(a), (b), and (c); .427(b), (c)(3), and (d)(1); .428(a) and (b); .432(a), (c), and (d); .435(g)

Export Health Certificates - Federal Government (Foreign)

none

582

10.0000

5,820.00

0.5000

2,910.00

0.00

93.103(a)(3)(ii); .103(a)(3)(v); .210(b); .309(a) and (b); .404(a)(4)(ii) and (iii); .412(b), (d)(2)(i)(E), and (d)(2)(ii); .511(a) and (b)

Letter of Credit, Cashier’s Check, Certified Check, or Money Order - Business

none

40

10.0000

400.00

0.1000

40.00

0.00

93.103(3)(iv)(A), .204(a)(3)(iv)(A), .304(a)(2)(vi), .404(a)(4)(iv)(A), .504(a)(4)(iv)(A)

Written Notice of Cancellation from Importer - Business

none

1

1.0000

1.00

0.2500

0.25

0.00

SUBTOTAL

1,207.00

12,043.00

4,058.08

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.

IMPORTATION OF ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

93.301(d)(1)(ii)(A-C)

Daily Record of Horse’s Activities - Individual

none

500

1.0000

500.00

0.1600

80.00

0.00

93.301(d)(ii)(A-C)

Recordkeeping - Horses for Association and Trainer - Business

none

0.00

0.00

500

12.000

6,000.00

93.301(f)(6)

Written Request to Change Horse’s Itinerary or Method of Transport - Individuals or household

none

6

1.0000

6.00

0.3330

2.00

0.00

93.301(a), .304(a), .404(a)(4)(ii), .412(a), .417(a), .422(a), .424(a), .504(a), .802(a); 98.4(a), .10; .34(a), .36(a)

Appeal or Hearing of Import Permit Withdrawal - Individual or Household

none

1

1.0000

1.00

6.0000

6.00

0.00

93.301(h)(1)

Written Agreement with State for CEM (Monitoring by State) - State, Local ,or Tribal Group

none

21

10.0000

210.00

3.5000

735.00

0.00

93.301(h)((5)

Opportunity to Present View on Suspension - Individual or Household

none

1

1.0000

1.00

6.0000

6.00

0.00

93.404(c)(2), .504(c)(2)

Zoological Park Inspection Report - Business

VS 17-65A

3

2.0000

6.00

5.0000

30.00

0.00

SUBTOTAL

532.00

724.00

859.00

500

6,000.00

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.

IMPORTATION OF ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

93.404 (c)(1)(ii) and (c)(4); .504(c)(1)(ii) and (c)(4)

Agreement for the Importation, Quarantine, and Exhibition of Certain Wild Ruminants and Wild Swine - Business

VS 17-65B

6

1.0000

6.00

0.5000

3.00

0.00

93.404(c)(2), .504(c)(2)

Report of Zoo Animals with Suspected Cases of Contagious or Communicable Diseases - Business

VS 17-65C

1

2.0000

2.00

0.1900

0.38

0.00

93.404(c)(4), .504(c)(4)

Agreement for the Transfer of Wild Animals - Business

VS 17-65D

1

1.0000

1.00

0.1900

0.19

0.00

93.301(b)(1)(ii), .412(a), (d)(1)(i)(B)

Application for Approval of Quarantine or Holding Facility (Letter) - Business

none

1

1.0000

1.00

0.2500

0.25

0.00

Application for Approval of Quarantine or Holding Facility (Letter) - Indivdual or Households

none

1

1.0000

1.00

0.2500

0.25

0.00

93.103(a((2)(vii), .301(h)(5), .304(a)(2)

Opportunity for Hearing to Present Views on Facility Withdrawal and Written Withdrawal by Facility Operator - Business

none

1

1.0000

1.00

6.0000

6.00

0.00

93.301(f)(12) and 93.304(a)(1)(iii)(J)

Trust Fund or Compliance Agreement for Privately Owned Equine Quarantine Facilities - Business

none

28

1.0000

28.00

0.1900

5.32

0.00

93.412(d)(4)(v)

Daily Log of Privately Operated Quarantine Facility for Ruminants, Swine, and Equine

none

100

1.0000

100.00

0.0160

1.60

0.00

SUBTOTAL

139.00

140.00

16.99

0.00

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.

IMPORTATION OF ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

93.412(d)(4)(v)

Recordkeeping – Daily Log of Privately Operated Quarantine Facility for Ruminants, Swine, and Equine - Business

none

0.00

0.00

23

0.250

5.75

93.103(a)(1), 93.210(a)

Application for Approval of Quarantine Facilities and Request for Transfer of Operations to Another Facility for Birds - Business

VS 17-11

28

1.0000

28.00

0.5000

14.00

0.00

93.210(a), .218(b), .309(a) and (b), .321,.325, .412(a) and (b), .424(b)

Written Request for Inspection, Other Services, and Dipping, VS 17-32 (Application for Inspection and Dipping) - Business

VS 17-32

175

121.0000

21,175.00

0.2500

5,293.75

0.00

93.427(b)

Importer or Agent Certification Free of Fever Tick (Letter) - Foreign Government

none

175

53.0000

9,275.00

0.1900

1,762.25

0.00

93.704(a), .802(a)

72-Hour Prior Arrival Notice (Hedgehogs, and Tenrecs, Elephants, Hippos, Rhinos, and Tapirs) - Business

none

10

3.0000

30.00

0.0830

2.49

0.00

93.435(d)

Owner Affidavit for Sheep and Goats from Scrapie Regions - Business

none

0.00

0.00

0.00

92.2(a)

Request for Recognition of the Animal Health Status of a Region - Federal Government (Foreign)

none

6

1.0000

6.00

1.0000

6.00

0.00

92.2(b)

Application for Recognition of the Animal Health Status of a Region - Federal Government (Foreign)

none

6

1.0000

6.00

80.0000

480.00

0.00

SUBTOTAL

400.00

30,520.00

7,558.49

23

5.75

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 ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

92.2(c)

Application for Recognition of a Region as Historically Free of a Disease - Federal Government (foreign)

none

1

1.0000

1.00

60.0000

60.00

0.00

92.2(b) and (g)

Request for Additional Information about a Region - Federal Government (Foreign)

none

13

1.0000

13.00

30.0000

390.00

0.00

Appeal Classification of Animal Health Status - Federal Government (Foreign)

none

1

1.0000

1.00

10.0000

10.00

0.00

Written Recommendations Have Been Implemented by the Region - Federal Government (Foreign)

none

3

1.0000

3.00

20.0000

60.00

0.00

93.314(b)

Certification for Horses that Spend Less than 60 Days in a Region - Business

none

50

1.0000

50.00

0.1000

5.00

0.00

93.304(a)(1)(iii)(C)

Permanent Electronic ID, Compatible Reader

none

0.00

0.00

0.00

Business

1

30.0000

30.00

0.1000

3.00

0.00

Hobby Farms

1

30.0000

30.00

0.1000

3.00

0.00

Foreign

1

30.0000

30.00

0.1000

3.00

0.00

State

1

30.0000

30.00

0.1000

3.00

0.00

Non-Profit

1

30.0000

30.00

0.1000

3.00

0.00

SUBTOTAL

73.00

218.00

540.00

0.00

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.

IMPORTATION OF ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

93.301(f)(5)(vii)

Photographs for ID

none

0.00

0.00

0.00

Business

1

30.0000

30.00

0.2500

7.50

0.00

Hobby Farms

1

30.0000

30.00

0.2500

7.50

0.00

Foreign

1

30.0000

30.00

0.2500

7.50

0.00

State

1

30.0000

30.00

0.2500

7.50

0.00

Non-Profit

1

30.0000

30.00

0.2500

7.50

0.00

93.301(f)(5)(xi)

Written Plan for Medical Treatment (Business)

none

1

6.0000

6.00

0.2500

1.50

0.00

93.301(j)(4)

Statement for Horses Imported from a Country Affected with Screwworm (foreign)

none

1

720.0000

720.00

0.5000

360.00

0.00

93.301(b)(1)(ii), 93.301(c)(1)

Checklist for the Approval of Permanent, Privately Owned Equine Quarantine Facilities (Letter)

none

0.00

0.00

0.00

Business

1

1.0000

1.00

1.0000

1.00

0.00

Hobby Farms

1

1.0000

1.00

1.0000

1.00

0.00

Non-Profit

1

1.0000

1.00

1.0000

1.00

0.00

SUBTOTAL

10.00

879.00

402.00

0.00

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.

IMPORTATION OF ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

These forms are approved under 0579-0090

VS FORM 10-4, SPECIMEN SUBMISSION; VS FORM I0-4A, CONTINUATION SHEET FOR SPECIMEN SUBMISSION

VS 104 and VS 10-4A

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.

IMPORTATION OF ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

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.

IMPORTATION OF ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

September 1, 2013

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)

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 ANIMAL AND POULTRY, ANIMAL/POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGICAL ANIMALS

0579-0040

DATE PREPARED

August 1, 2013

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.

0579-0040

DATE PREPARED

August 1, 2013

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