Aphis 71

0040 71 20170830.xlsx

Importation of Animals and Poultry, Animal and Poultry Products, Certain Animal Embryos, Semen, and Zoological Animals

APHIS 71

OMB: 0579-0040

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0579-0040 can be found here:

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

0579-0040

DATE PREPARED

August 14, 2017

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

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 - Individuals (same)

none

150

150.00

0.25

38.00

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

none

7,272

0.16

1,164.00

Business

37,362

0.16

5,978.00

Farms

28,089

0.16

4,494.00

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 Confinement in Personal Possession Declaration and Affirmation Under Oath - Individuals

VS 17-8

80.00

0.50

40.00

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

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

VS 17-135

108

432.00

0.19

82.00

SUBTOTAL

662.00

160.00

72,723.00

11,636.00

TOTAL OF ALL PAGES

8,412.00

470,810.00

295,864.00

74,240.00

17,987.00

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

545,050.00

313,851.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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 (same)

none

1.00

Individuals (same)

none

1.00

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

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

none

1.00

0.25

1.00

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

9.00

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

Daily Register and Recordkeeping for Owner or Manager for Ratites and Hatching Eggs - Individuals (same)

none

1.00

0.15

1.00

4.00

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 - Cattle/Swine - Individuals

VS 17-29

269

16,678.00

0.25

4,170.00

Business

347

34,006.00

0.25

8,502.00

SUBTOTAL

50,688.00

12,676.00

13.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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)

Farms

450

15,300.00

0.19

2,907.00

93.101(b)(3)(v)

Owner or Manager and Country of Export Quarterly Submission of Registers - Individuals (same)

none

80.00

0.05

4.00

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 (same)

none

20.00

0.30

6.00

4.00

80.00

93.103(a)(2)(vii)

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

none

1.00

6.00

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 (same)

none

1.00

1.50

2.00

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 (same)

none

24.00

2.00

48.00

SUBTOTAL

15,426.00

2,973.00

80.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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)(2)(iii)

Daily Log and Recordkeeping for Identification Record for Birds - Business (same)

VS 17-12

12.00

0.08

1.00

12.00

93.106(c)(4)

Additional Requirements for the Quarantine of Birds - Business (same)

none

1.00

2.00

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

729

27,702.00

0.50

13,851.00

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 (same)

none

143

7,436.00

0.10

744.00

SUBTOTAL

35,151.00

14,598.00

12.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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)

93.104(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

196

754

147,784.00

0.50

73,892.00

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 (same)

none

400.00

0.10

40.00

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 (same)

none

1.00

0.25

1.00

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

Daily Record of Horse’s Activities - Individual

none

500

500.00

0.16

80.00

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

Recordkeeping - Horses for Association and Trainer - Business

none

500

12.00

6,000.00

93.301(f)(6)

Written Request to Change Horse’s Itinerary or Method of Transport - Individuals (same)

none

6.00

0.33

2.00

SUBTOTAL

148,691.00

74,015.00

500

6,000.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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(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 - Individuals (Same as Daily Record of Horse Activites)

none

1.00

6.00

93.301(h)(1)

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

none

210.00

3.50

735.00

93.301(h)((5)

Opportunity to Present View on Suspension - Individuals

none

1.00

6.00

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

Zoological Park Inspection Report - Business (formerly VS 17-65A) (same)

none

2.00

5.00

10.00

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 (formerly VS 17-65B) (same)

none

1.00

0.50

1.00

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

Reporting of Zoo Animals with Suspected Cases of Contagious or Communicable Diseases - Business (formerly VS 17-65C) (same)

none

2.00

0.19

1.00

SUBTOTAL

217.00

759.00

0.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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

Agreement for Transfer of Certain Wild Animals - Business (formerly VS 17-65D) (same)

none

1.00

0.19

1.00

93.301(b)(1)(ii), 2, .412(a), (d)(1)(i)(B)

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

none

22.00

0.25

6.00

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

none

1.00

0.25

1.00

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 (same)

none

17.00

6.00

102.00

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

Trust Fund or Compliance Agreement for Horses - Business (same)

none

28.00

0.19

5.00

93.412(d)(4)(vi)

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

none

100

100.00

0.02

2.00

SUBTOTAL

169.00

117.00

0.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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)(vi)

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

none

0.25

6.00

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

Application for Approval of Quarantine Facilities and Request for Transfer of Operations to Another Facility for Birds or Poultry - Business (same)

VS 17-11

28.00

0.50

14.00

Individuals (same)

1.00

0.50

1.00

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 (same)

VS 17-32

350

181

63,350.00

0.50

31,675.00

93.427(b)

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

none

175

9,275.00

0.19

1,762.00

93.704(a), .802(a)

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

none

1,350.00

0.33

446.00

93.435(d)

Owner Affidavit for Sheep and Goats from Scrapie Regions - Business

none

1.00

SUBTOTAL

74,005.00

33,899.00

6.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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(a)

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

none

5.00

1.00

5.00

92.2(b)

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

none

5.00

80.00

400.00

92.2(c)

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

none

2.00

60.00

120.00

92.2(b) and (g)

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

none

7.00

30.00

210.00

92.2

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

none

1.00

10.00

92.2

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

none

3.00

20.00

60.00

SUBTOTAL

23.00

805.00

0.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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)

93.314(b)

Certification for Equids that Spend Less than 60 Days in a Region - Business (same)

none

50.00

0.10

5.00

93.304(a)(1)(iii)(B)

Permanent Electronic ID, Compatible Reader

none

0.00

Business (same)

30.00

0.10

3.00

Hobby Farms (same)

30.00

0.10

3.00

Foreign (same)

30.00

0.10

3.00

State (same)

30.00

0.10

3.00

SUBTOTAL

170.00

17.00

0.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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)

Non-Profit (same)

30.00

0.10

3.00

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

Photographs for Identification of Horses

none

Business (same)

30.00

0.25

8.00

Individuals (same)

30.00

0.25

8.00

Foreign (same)

30.00

0.25

8.00

State (Same)

30.00

0.25

8.00

Non-Profit (same)

30.00

0.25

8.00

SUBTOTAL

180.00

43.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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)(xi)

Written Plan for Medical Treatment of Horses (Business) (Same)

none

6.00

0.25

2.00

93.301(j)(4)

Statement/Certificate for Animals Entering the United States from Countries Affected with Screwworm (foreign government) (same)

none

720

720.00

0.50

360.00

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

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

none

Business (Same)

1.00

Individuals (same)

1.00

Non-Profit

1.00

SUBTOTAL

729.00

365.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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)

93.204, 93.304, 93.404, 93.504, 93.106

Speciment Submission - Business

VS 10-4 and 10-4A

5,500

5,500.00

0.33

1,815.00

Notice of Arrival - Business

none

500

25,000.00

0.16

4,000.00

Individuals (same)

1.00

0.16

1.00

Emergency Action Notification - Business (same)

PPQ 523

1.00

Application for Permit To: Import or Transport Controlled Material or Organisms or Vectors (Business)

VS 16-3

9.00

0.50

5.00

93.906(b)

Refusal of Entry and Order to Dispose of Fish (Business) (same )

17-136

1.00

0.08

1.00

93.906(a)

Recordkeeping (Business)

0.00

960

0.25

240.00

SUBTOTAL

30,512.00

5,823.00

960

240.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

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

0579-0040

DATE PREPARED

August 14, 2017

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

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)

93.904 (c)(3)

Cleaning and Disinfection Certificate (Foreign Gov't) (same)

none

1.00

93.404

Premises Information (Herd of Origin Certificate and Annex) (Foreign Government) (same)

none

42,120

42,120.00

0.75

31,590.00

93.406

TB History Certificate (FOREIGN GOVERNMENT)

none

28,080

28,080.00

4.00

112,320.00

93.427(b)(2)

Dip Certificate (Constancial de Tratamiento Garrapaticida y Libre de Ectoparasitos) (FOREIGN GOVERNMENT) (same)

none

117

120

14,040.00

0.33

4,633.00

93.427( c)(1)

Brand (Business) (same)

none

702

28,080.00

0.02

562.00

On-Hold Shipment Notification Application (Business) (same)

VS 16-79

610

610.00

0.50

305.00

SUBTOTAL

112,931.00

149,411.00

0.00

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

APPLICATION OF ANIMALS AND POULTRY, ANIMAL AND POULTRY PRODUCTS, CERTAIN ANIMAL EMBRYOS, SEMEN, AND ZOOLOGIAL ANIMALS

0579-0040

DATE PREPARED

August 14, 2017

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

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)

Report of Entry, Shipment of Restricted Imported Animal Products and Animal By-Products, and Other Material (Business) (same)

VS 16-78

250

1,250.00

0.16

200.00

0.00

Individuals (same)

1.00

0.16

1.00

98.34(d), 98.35(e), 98.36(a)(2)

Certificate for Importing Sheep and Goat Semen from Canada (Business) (same)

VS 17-139

4.00

0.25

1.00

0.00

93.427(b)(1)(ii)

Seals (Foreign Government) (same)

none

1.00

0.00

SUBTOTAL

1,256.00

203.00

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

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

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

SUBTOTAL

0.00

File Type	application/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified	0000-00-00
File Created	0000-00-00