Aphis 71

0378 71 20180613.xlsx

Importation of Fresh Pitaya Fruit from Central America into the Continental United States

APHIS 71

OMB: 0579-0378

Document [xlsx]
Download: xlsx | pdf















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 Fresh Pitaya Fruit from Central American into the Continental United States 0579-0378




DATE PREPARED


June 13, 2018
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)
319.56.55 (a) Production Site Certification (Foreign government) None 7 1 7 1.00 7


319.56.55 (a)(3) Review & maintain documents (Foreign government) (same respondents as production site certification) None 7 1 7 0.50 4 7 0.160 1.00
319.56.55 (b)(2) Packinghouse Registration (Foreign Officials) (same respondents as production site certification) None 7 3 21 0.50 11


319.56.55 (b)(2) Packinghouse Registration (business) None 21 1 21 0.50 11


319.56.55 (a) (1) Bilateral workplan (Foreign government) (same respondents as production site certification) None 7 1 7 80.00 560



SUBTOTAL


63
593 7
1.00

TOTAL OF ALL PAGES


150,425
1,288 7
1.00
TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c


150,432
1,289















































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 Fresh Pitaya Fruit from Central American into the Continental United States 0579-0378




DATE PREPARED


June 13, 2018
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)
319.56.55 (f)(2) Shipping documents identifying the places of production (Business) None 10 5 50 0.50 25


319.56.55 (h) Phytosanitary certificate with additional declaration (Foreign government) (same respondents as production site certification) None 7 7 50 0.50 25


319.56.55 (h) Phytosanitary certificate with additional declaration (business) (same respondent as shipping documents) None 10 5 50 0.50 25


319.56.55 (b)(2) Production Site Registration (Business) None 28 1 28 0.50 14


319.56.55 (b)(2) Production Site Registration (Foreign Government) (same respondents as production site certification) None 7 4 28 0.50 14


319.56.55 (5)(b) Box Markings (Business) (same respondents as shipping documents) None 10 15,000 150,000 0.0016 240



SUBTOTAL


150,206
343















































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 Fresh Pitaya Fruit from Central American into the Continental United States 0579-0378




DATE PREPARED


June 13, 2018
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)
319.56.55(b)(1) Production Site Training Program (foreign government) (same respondents as production site certification) None 7 4 28 8.00 224



Emergency Action Notification (business) (same respondent as shipping document) PPQ 523 1 1 1 1.00 1


319.56.55(a)(2) Packinghouse Inspections and Investigations (business) (same respondents as packinghouse registrations) None 21 3 63 1.00 63


319.56.55(a)(2) Packinghouse Inspections and Investigations (foreign government) (same respondents as production site certification) None 7 9 63 1.00 63



Notice of Arrival (business) (same respondent as shipping document) None 1 1 1 1.00 1














SUBTOTAL


156
352















































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
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 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
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00





0
0

0.00

SUBTOTAL


0
0 0
0.00
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

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