Burden Spreadsheet

new Copy of 0596-0110 2017 NVUM Burden Spreadsheet v08_16_2017.xlsm

National Visitor Use Monitoring

Burden Spreadsheet

OMB: 0596-0110

Document [xlsx]
Download: xlsx | pdf

















INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-I: 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.











National Visitor Use Monitoring 0596-0110










DATE PREPARED






July 6, 2017



IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN











REPORTS RECORDS RESPONDENT COST





















TOTAL







FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD- COST TOTAL
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS PER COST
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J) HOUR (Col. H x L)








RESPONDENT



KEEPER


(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M)

Basic Survey English Version
9,300 1.00 9,300.00 0.1500 1,395.00

0.00 $8.66 $12,080.70

Basic Survey, English version, with R6 addendum
2,200 1.00 2,200.00 0.1800 396.00

0.00 $8.66 $3,429.36

Basic Survey, English version, with R10 addendum
300 1.00 300.00 0.1800 54.00

0.00 $8.66 $467.64

Economics Survey, English version
11,800 1.00 11,800.00 0.1800 2,124.00

0.00 $8.66 $18,393.84

Satisfaction Survey, English, version
11,800 1.00 11,800.00 0.1800 2,124.00

0.00 $8.66 $18,393.84

Basic Survey, Spanish version
100 1.00 100.00 0.1900 19.00

0.00 $8.66 $164.54

SUBTOTAL


35,500.00
6,112.00 0.00
0.00
$52,929.92

TOTAL OF ALL PAGES


45,000.00
6,386.00 0.00
0.00
$55,302.76
TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c


45,000.00
6,386.00



$55,302.76



















































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.











National Visitor Use Monitoring 0596-0110










DATE PREPARED






July 6, 2017



IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN











REPORTS RECORDS RESPONDENT COST





















TOTAL







FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD- COST TOTAL
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS PER COST
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J) HOUR (Col. H x L)








RESPONDENT



KEEPER


(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M)

Economics Survey, Spanish version
100 1.00 100.00 0.2400 24.00

0.00 $8.66 $207.84

Satisfaction Survey, Spanish Version
100 1.00 100.00 0.2400 24.00

0.00 $8.66 $207.84

Alaska cruise ship version
300 1.00 300.00 0.0600 18.00

0.00 $8.66 $155.88

Viewing Corridor survey
700 1.00 700.00 0.0600 42.00

0.00 $8.66 $363.72

Non-Response
8,300 1.00 8,300.00 0.0200 166.00

0.00 $8.66 $1,437.56





0.00
0.00

0.00 $8.66 $0.00

SUBTOTAL


9,500.00
274.00 0
0.00
$2,372.84



















































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.











National Visitor Use Monitoring 0596-0110










DATE PREPARED






July 6, 2017



IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN











REPORTS RECORDS RESPONDENT COST





















TOTAL







FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD- COST TOTAL
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS PER COST
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J) HOUR (Col. H x L)








RESPONDENT



KEEPER


(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M)



0 0.0000 0.00 0.0000 0.00

0.00 $0.00 $0.00



0 0.0000 0.00 0.0000 0.00

0.00 $0.00 $0.00



0 0.0000 0.00 0.0000 0.00

0.00 $0.00 $0.00



0 0.0000 0.00 0.0000 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
$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.











National Visitor Use Monitoring 0596-0110










DATE PREPARED






July 6, 2017



IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN











REPORTS RECORDS RESPONDENT COST





















TOTAL







FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD- COST TOTAL
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS PER COST
REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J) HOUR (Col. H x L)








RESPONDENT



KEEPER


(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M)





0.00
0.00

0.00
$0.00





0.00
0.00

0.00
$0.00





0.00
0.00

0.00
$0.00





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
$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.











National Visitor Use Monitoring 0596-0110










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.












0563-New










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




















































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




















































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

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

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