|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
|
|
|
|
| SCRAPIE IN SHEEP AND GOATS; INTERSTATE MOVEMENT RESTRICTIONS AND INDEMNITY PROGRAM |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| November 25, 2016 |
| 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) |
| 54.2 |
Cooperative Agreement/Grant Forms: Application for Federal Assistance (State/Tribe) - covered under 4040-0004 |
SF 424 |
27 |
1.00 |
27.00 |
0.75 |
20 |
|
|
|
| ` |
Not for profit |
|
Sutton, Diane L - APHIS:
ASI, AGF, NIAA
3 |
1.00 |
3.00 |
0.75 |
2 |
|
|
|
| 54.2 |
Cooperative Agreement /Grant Forms - Budget Information (State/Tribe) - covered under 0348-0044 |
SF 424A |
27 |
1.00 |
27.00 |
3.00 |
81 |
|
|
|
|
Not for profit |
|
3 |
1.00 |
3.00 |
3.00 |
9 |
|
|
|
| 54.2 |
Cooperative Agreement /Grant Forms - Assurances - Non-Construction Program (State/Tribe) - covered under 4040-0040 |
SF 424B |
27 |
1.00 |
27.00 |
0.25 |
7 |
|
|
|
|
Not for profit |
|
3 |
1.00 |
3.00 |
0.25 |
1 |
|
|
|
| 54.2 |
Cooperative Agreement /Grant Forms - Disclosure of Lobbying Activities (State/Tribe) - covered under 0348-0046 |
SF LLL |
27 |
1.00 |
27.00 |
0.50 |
14 |
|
|
|
|
Not for profit |
|
3 |
1.00 |
3.00 |
0.50 |
2 |
|
|
|
| 54.2 |
Cooperative Agreement/Federal Financial Report (State/Tribe) - covered under 0348-0061 |
SF 425 |
27 |
4.00 |
108.00 |
2.00 |
216 |
|
|
|
|
Not for profit |
|
3 |
4.00 |
12.00 |
2.00 |
24 |
|
|
|
|
SUBTOTAL |
|
150 |
|
240 |
|
375 |
0.00 |
|
0.00 |
|
TOTAL OF ALL PAGES |
|
|
|
480,640 |
|
171,597 |
374,054.00 |
|
849,931.00 |
| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c |
|
166,000 |
|
854,694 |
|
1,021,528 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
|
|
|
|
| SCRAPIE IN SHEEP AND GOATS |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| November 1, 2016 |
| 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) |
| 54.3 (b) |
Request for Information: Record of Animals Moved or Record of Animals Acquired (Business) |
VS 5-18 and 5-18A, or equivelant |
Sutton, Diane L - APHIS:
SFCP plus infected/source
456 |
1.00 |
456.00 |
0.25 |
114 |
|
|
|
|
State |
|
10 |
2.00 |
20.00 |
0.25 |
5 |
|
|
|
| 54.3 (b) |
Individual Animal Information Report (Business) |
VS 5-20 or equivelant |
Sutton, Diane L - APHIS:
SFCP plus inf/source
456 |
1.00 |
456.00 |
1.00 |
456 |
|
|
|
|
State |
|
Sutton, Diane L - APHIS:
estimated state contribution
10 |
2.00 |
20.00 |
1.00 |
20 |
|
|
|
| 54.3 (b) and 54.8 (f) |
Flock Inspection and Epidemiology Report or Scrapie Epidemiology Report (Business) |
VS 5-19 or VS 5-19D |
Sutton, Diane L - APHIS:
number of new investigations in FY 2014
50 |
1.00 |
50.00 |
5.50 |
275 |
|
|
|
|
State |
|
Sutton, Diane L - APHIS:
number estimated mangaged by states
20 |
2.00 |
40.00 |
5.50 |
220 |
|
|
|
| 54.4(a) |
Appraisal and Idemnity Claim and Continuation Sheet (Business) |
VS 1-23, 1-23A |
Sutton, Diane L - APHIS:
number of indemnity requests in FY 2014
33 |
1.00 |
33.00 |
1.00 |
33 |
|
|
|
|
State |
|
1 |
1.00 |
1.00 |
1.00 |
1 |
|
|
|
| 54.5 |
Written Agreement/Certification (Business) |
|
Sutton, Diane L - APHIS:
number of indemnity requests FY 2014
33 |
1.00 |
33.00 |
0.25 |
8 |
|
|
|
| 54.6 |
Proceeds from Animals Sold for Slaughter (Business) |
VS 1-24 |
1 |
1.00 |
1.00 |
0.25 |
1 |
|
|
|
|
SUBTOTAL |
|
1,070.00 |
|
1,110.00 |
|
1,133.25 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
|
|
|
|
| SCRAPIE IN SHEEP AND GOATS |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| November 1, 2016 |
| 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) |
| 54.8 |
Flock Plan and Recordkeeping (Business, including breed registries) |
|
Sutton, Diane L - APHIS:
7 new in FY 2014
10 |
1.00 |
10.00 |
1.00 |
10 |
25 |
10.00 |
250 |
|
State |
|
Sutton, Diane L - APHIS:
guess on number managed by State
2 |
1.00 |
2.00 |
1.00 |
2 |
52 |
10.00 |
520 |
| 54.8 |
Post Exposure Management and Monitoring Plan and Recordkeeping (Business, including breed registries) |
|
Sutton, Diane L - APHIS:
15 new in FY 2104
17 |
1.00 |
17.00 |
1.00 |
17 |
660 |
10.00 |
6,600 |
|
State |
|
3 |
1.00 |
3.00 |
1.00 |
3 |
52 |
10.000 |
520.00 |
| 54.8 (e) |
Report Suspect/Dead Animals (Business) |
|
Sutton, Diane L - APHIS:
based on estimate of on-farm submissions not associated with clean up in FY 2014 1090 collected - 2/3 of 643 indemnified
1,048 |
1.00 |
1,048.00 |
0.17 |
178 |
|
|
0 |
|
State |
|
66 |
4.00 |
264.00 |
0.17 |
45 |
|
|
0 |
| 54.8 (g) |
Scrapie PEMMP Inspection Report and Recordkeeping (Business) |
VS 5-19C |
Sutton, Diane L - APHIS:
99 PEMMP in place as of 4/2015
99 |
1.00 |
99.00 |
0.17 |
17 |
660 |
5.00 |
3300 |
|
State |
|
Sutton, Diane L - APHIS:
guess on how many managed by State
10 |
2.00 |
20.00 |
0.17 |
3 |
52 |
5.00 |
260 |
| 54.8 (h)(4) |
Recordkeeping for Plans (Business) |
|
|
|
|
|
|
Sutton, Diane L - APHIS:
number PEMMPs 4/2015
99 |
5.00 |
495 |
| 54.11 (a) (8) |
Cooperative State-Federal Scrapie Control Program, Scrapie Test Record and Cont. Sheet (Business) |
VS 5-29, VS 5-29A |
Sutton, Diane L - APHIS:
combination of lab reports plus field submissions consider adobe form for 5-29
76 |
2.00 |
152.00 |
2.00 |
304 |
3 |
10.00 |
30 |
|
State/Tribe |
|
Sutton, Diane L - APHIS:
one lab state opperated plus guess on how many State submissions
11 |
4.00 |
44.00 |
2.00 |
88 |
1 |
10.00 |
10 |
|
SUBTOTAL |
|
1,342.00 |
|
1,659.00 |
|
667 |
1,604 |
|
11,985.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
|
|
|
|
| SCRAPIE IN SHEEP AND GOATS |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| November 1, 2016 |
| 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) |
| 54.11(a)(8) |
Specimen Submission (Business) |
VS 10-4 |
Sutton, Diane L - APHIS:
number on-farm + RSSS sites
1,200 |
4.46 |
5,346.00 |
1.00 |
5,346 |
|
|
|
|
State/Tribe |
|
Sutton, Diane L - APHIS:
number of approved labs 18
18 |
297.00 |
5,346.00 |
1.00 |
5,346 |
18 |
10.00 |
180 |
| 54.11(b) |
Request for Laboratory Approval (State) (NEW) |
|
1 |
1.00 |
1.00 |
2.00 |
2 |
|
|
|
|
Request for Laboratory Approval (Business) |
|
1 |
1.00 |
1.00 |
2.00 |
2 |
|
|
|
| 54.11(b) |
Agreement to Conduct the Official Histopathology Examination for the Diagnosis of Scrapie (State) |
VS 5-21 |
1 |
1.00 |
1.00 |
0.10 |
1 |
|
|
0 |
| 54.21 |
Application for the Scrapie Free Flock Certification Program (Business) |
VS 5-22 |
Sutton, Diane L - APHIS:
new SFCP participants in FY 2014
18 |
1.00 |
18.00 |
0.16 |
3 |
|
|
0 |
| 54.21 |
Scrapie SFCP Flock Inspection Report (Initial Flock Inspection) - and Recordkeeping (Business) |
VS 5-19A |
Sutton, Diane L - APHIS:
new SFCP participants in FY 2014
18 |
1.00 |
18.00 |
2.00 |
36 |
250 |
10.00 |
2,500 |
|
State |
|
2 |
4.00 |
8.00 |
2.00 |
16 |
52 |
10.00 |
520 |
| 54.21 |
Scrapie SFCP Flock Inspection Report (Annual Inspection Report) - and Recordkeeping (Business) |
VS 5-19B |
Sutton, Diane L - APHIS:
based on current number plus expected increase 4/2015
470 |
1.00 |
470.00 |
1.00 |
470 |
1,730 |
10.00 |
17,300.00 |
|
State |
|
10 |
10.00 |
100.00 |
1.00 |
100 |
52 |
10.00 |
520 |
| 79.2(a) |
Owner Statement (Business) |
|
45,000 |
4.00 |
180,000.00 |
0.08 |
14,400 |
45,000 |
3.00 |
135,000 |
|
SUBTOTAL |
|
46,739.00 |
|
191,309.00 |
|
25,722 |
47,102 |
|
156020 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
|
|
|
|
| SCRAPIE IN SHEEP AND GOATS |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| November 1, 2016 |
| 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) |
| 79.3(a) |
Report for Consignments when Identification is Applied (Business) |
|
Sutton, Diane L - APHIS:
guess based on number of approved markets handling sheep and goats
104 |
26.00 |
2,704.00 |
0.30 |
811 |
|
|
|
| 79.3(a) |
Agreement to use blue "slaughter only tags" (Business) (NEW) |
|
Sutton, Diane L - APHIS:
assumes 20% renew plus 10 new per year
30 |
1.00 |
30.00 |
0.30 |
9 |
|
|
|
| 79.2(d) |
Recordkeeping, Animals Moved in Interstate Commerce (Business) |
|
|
|
|
|
|
Sutton, Diane L - APHIS:
used 2012 census # SG farms x 75% to account for those not engaging interstate
162,596 |
3.00 |
487,787 |
| 79.2(f) |
Request for Approval to Produce Official Identification Divices (Business) |
|
1 |
2.00 |
2.00 |
4.00 |
8 |
|
|
|
| 79.2(f)(2)(ii) (A) |
Agreement to Send official Eartags to Specified Individuals (Business) |
|
1 |
2.00 |
2.00 |
0.16 |
1 |
|
|
|
| 79.2(f)(2)(ii) (B) |
Monthly Report of Official Identification Devices Produced (Business) |
|
Sutton, Diane L - APHIS:
we have made this report voluntary only 1 still submits it
1 |
12.00 |
12.00 |
2.00 |
24 |
|
|
|
| 79.2(f)(2)(ii) (C) |
Data Entry of Official ID Devices Produced (Business) |
|
Sutton, Diane L - APHIS:
number of approved tag manufactures 4/2015
6 |
Sutton, Diane L - APHIS:
number of orders 2014 divided by number of manufacturers
3382.00 |
20,292.00 |
0.17 |
3,450 |
|
|
|
| 79.2 (g) |
Request for Approval of New Device Type (Business) |
|
1 |
1.00 |
1.00 |
4.00 |
4 |
|
|
|
| 79.4 (C) |
Herd Owner Notification of Designation of Flocks or Animals (State) |
|
Sutton, Diane L - APHIS:
guess based on number of inf/source and new PEMMPS FY 2014
30 |
2.00 |
60.00 |
0.75 |
45 |
|
|
|
| 79.5 |
Permit for Movement of Restricted Animal (Business) |
VS 1-27 |
25 |
1.00 |
25.00 |
1.00 |
25 |
|
|
|
|
State |
|
5 |
1.00 |
5.00 |
1.00 |
5 |
|
|
|
|
SUBTOTAL |
|
204.00 |
|
23,133.00 |
|
4,382 |
162,596 |
|
487,787 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
|
|
|
|
| SCRAPIE IN SHEEP AND GOATS |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| November 1, 2016 |
| 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) |
| 79.5 |
Certificate of Vet Inspection - United States Origin Health Certificate (Business) |
VS 17-140 or equivalent |
Sutton, Diane L - APHIS:
guess includes acredited vets and owners
27,500 |
5.50 |
151,250.00 |
0.75 |
113,438 |
|
|
|
| 79.5 |
Certificate of Vet Inspection - United States Origin Health Certificate and Recordkeeping (State) (NEW) |
VS 17-140 or equivalent |
Sutton, Diane L - APHIS:
states process these
50 |
1512.50 |
75,625.00 |
0.25 |
18,906 |
50 |
100.00 |
5,000 |
| 79.6 |
Consistent State Application - Application for Scrapie Classification, Classification Renewal, or Reclassification of a State (State) |
VS 5-24 |
50 |
1.00 |
50.00 |
8.00 |
400 |
|
|
|
| 79.2 |
Application for ID Numbers including Blue Tags (Business) |
|
Sutton, Diane L - APHIS:
number of tag orders in 2014
20,293 |
1.00 |
20,293.00 |
0.08 |
1,623 |
|
|
|
|
State/Tribe (and Recordkeeping) |
|
4 |
750.00 |
3,000.00 |
0.20 |
600 |
52 |
500.00 |
26,000 |
| 79.2 (b) |
Application for Premises ID Numbers (Business) |
|
Sutton, Diane L - APHIS:
number of new premises in SCS
9,209 |
1.00 |
9,209.00 |
0.17 |
1,566 |
|
|
|
|
State/Tribe (and Recordkeeping) (NEW) |
|
Sutton, Diane L - APHIS:
estimated number if IDs issued by States
5 |
684.00 |
3,420.00 |
0.20 |
684 |
52 |
10.00 |
520 |
| 79.2 (b) |
Recordkeeping, Identification (Business) |
|
|
|
|
|
|
Sutton, Diane L - APHIS:
used 2012 census # SG farms x 75% to account for those not engaging interstate
162,596 |
1.00 |
162,596 |
| 79.2 |
Declination to Participate or Provide Information (Business) (NEW) |
|
2 |
1.00 |
2.00 |
0.17 |
1 |
|
|
|
| 79.2 |
Determination of Age/Number of Animals (Business) (NEW) |
|
50 |
4.00 |
200.00 |
2.00 |
400 |
|
|
|
| 79.2 |
Receipt of Disposal Expenses (Payment of Indemnity) (NEW) |
|
2 |
1.00 |
2.00 |
0.17 |
1 |
|
|
|
|
SUBTOTAL |
|
57,165.00 |
|
263,051.00 |
|
137,619 |
162,750 |
|
194,116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
|
|
|
|
| SCRAPIE IN SHEEP AND GOATS |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| November 1, 2016 |
| 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) |
| 54.2 |
Cooperative Agreement or Grant Workplan (State/Tribe) |
|
27 |
1.00 |
27.00 |
40.00 |
1,080 |
|
|
|
|
Not for Profit |
|
3 |
1.00 |
3.00 |
Sutton, Diane L - APHIS:
based on input form our non-profit cooperators
10.00 |
30 |
|
|
|
| 54.2 |
Cooperative Agreement or Grant Financial Plan (State/Tribe) |
|
27 |
1.00 |
27.00 |
10.00 |
270 |
|
|
0 |
|
Not for Profit |
|
3 |
1.00 |
3.00 |
10.00 |
30 |
|
|
0 |
| 54.2 |
Cooperative Agreement or Grant Quarterly Report and Recordkeeping (State/Tribe) (NEW) |
|
27 |
4.00 |
108.00 |
2.00 |
216 |
1 |
8.00 |
8 |
|
Not for Profit (NEW) |
|
3 |
4.00 |
12.00 |
2.00 |
24 |
2 |
8.00 |
16 |
| 54.2 |
MOU Forms - Family (State) |
|
10 |
1.00 |
10.00 |
2.00 |
20 |
|
|
0 |
|
Designated Scrapie Epidemiologist Training (State) (NEW) |
|
15 |
1.00 |
15.00 |
0.25 |
4 |
|
|
|
|
Epidemiology and ID Compliance Report (State) (NEW) |
|
50 |
4.00 |
200.00 |
2.00 |
400 |
|
|
0 |
|
|
|
|
|
0.00 |
|
0 |
|
|
0 |
|
|
|
|
|
0.00 |
|
0 |
|
|
0 |
|
SUBTOTAL |
|
138.00 |
|
378.00 |
|
2,074 |
3 |
|
24 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
|
|
|
|
| SCRAPIE FLOCK CERTIFICATION, ANIMAL IDENTIFICATION, AND INDEMNIFICATION PROCEDURES |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| March 28, 2011 |
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
| SCRAPIE FLOCK CERTIFICATION, ANIMAL IDENTIFICATION, AND INDEMNIFICATION PROCEDURES |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| April 15, 2008 |
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
| SCRAPIE FLOCK CERTIFICATION, ANIMAL IDENTIFICATION, AND INDEMNIFICATION PROCEDURES |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| April 15, 2008 |
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
| SCRAPIE FLOCK CERTIFICATION, ANIMAL IDENTIFICATION, AND INDEMNIFICATION PROCEDURES |
0579-0101 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| April 15, 2008 |
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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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. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
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|
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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. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
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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. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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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. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
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|
|
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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. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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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. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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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. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
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0.00 |
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0.00 |
0 |
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0.00 |
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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.
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TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
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0581- |
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| DATE PREPARED |
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| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
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ANNUAL BURDEN |
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REPORTS |
RECORDS |
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TOTAL |
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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. |
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so state) |
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PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
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RESPONDENT |
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KEEPER |
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| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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0.00 |
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SUBTOTAL |
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0.00 |
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0.00 |
0 |
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0.00 |