Document Delivery Services Burden Data Work Sheet

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SUMMARY OF INFORMATION COLLECTION

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.

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TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

Information Collection for Document Delivery Services

0518-0027

(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.

DATE PREPARED

ANNUAL BURDEN

IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT

REPORTS

RECORDS
TOTAL

SECTION OF

DESCRIPTION

REGS.

FORMS NO (S)

NO. OF

NO OF

TOTAL ANNUAL

(If "none"

RESPONDENTS

RESPONSES

RESPONSES

PER

PER

(Col. D x E)

RESPONSE

so state)

HOURS

TOTAL

NO. OF

ANNUAL

RECORD-

HOURS

RECORD-

HOURS PER

KEEPING HOURS

(Col. F x G)

KEEPERS

RECORD-

(Col. I x J)

RESPONDENT
(A)

(B)

(C)

(D)

(E)

KEEPER
(F)

(G)

(H)

(I)

Not-for-Profit Institutions

None

530

7.0000

3,710.00

0.0166

61.59

Business/For-Profit

None

26

7.0000

182.00

0.0166

3.02

State, Local or Tribal Government

None

10

7.0000

70.00

0.0166

1.16

Federal Government (foreign)

None

24

7.0000

168.00

0.0166

2.79

SUBTOTAL

590.00

Prepared by user 10/24/2026

4,130.00

(J)

(K)

68.56

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