Supplemental Supporting Statement / Cover Sheet

SUPPLEMENTAL SUPPORTING STATEMENT FOR

THE CPSC GENERIC CLEARANCE OF

CONTESTS, CHALLENGES, AND AWARDS UNDER THE PRA

TITLE OF CONTEST:

[ ] VIDEO [ ] ESSAY [ ] POSTER [ ] OTHER ( )

DESCRIPTION OF THIS SPECIFIC COLLECTION

1. Basic contest description:

2. Objective for the contest:

3. Data elements to be collected:

4. Dates for the contest:

5. Eligible entrants/participants:

6. Number of winners expected:

7. Selection criteria for winner:

8. “Prize” or planned recognition for winner:

9. Other notes:

BURDEN HOUR COMPUTATION¹

Category of Respondent	No. of Respondents	Participation Time	Burden Hours

REQUESTED APPROVAL DATE:

NAME OF CONTACT PERSON:

TELEPHONE NUMBER:

NAME OF OFFICE/PROGRAM:

1 (Number of responses) x (estimated time in minutes) / 60 = annual burden hours

1